[Federal Register Volume 76, Number 173 (Wednesday, September 7, 2011)]
[Notices]
[Pages 55474-55499]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-22624]



[[Page 55473]]

Vol. 76

Wednesday,

No. 173

September 7, 2011

Part II





Department of Health and Human Services





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Secretarial Review and Publication of the Annual Report to Congress 
Submitted by the Contracted Consensus-Based Entity Regarding 
Performance Measurement; Notice

  Federal Register / Vol. 76, No. 173 / Wednesday, September 7, 2011 / 
Notices  

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DEPARTMENT OF HEALTH AND HUMAN SERVICES


Secretarial Review and Publication of the Annual Report to 
Congress Submitted by the Contracted Consensus-Based Entity Regarding 
Performance Measurement

AGENCY: Office of the Secretary of Health and Human Services, HHS.

ACTION: Notice.

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SUMMARY: This notice acknowledges the Secretary of the Department of 
Health and Human Services' (HHS) receipt and review of the annual 
report submitted to the Secretary and Congress by the contracted 
consensus-based entity as mandated by section 1890(b)(5) of the Social 
Security Act, as added by section 183 of the Medicare Improvements for 
Patients and Providers Act of 2008 (MIPPA). The statute requires the 
Secretary to publish the report in the Federal Register together with 
any comments of the Secretary on the report not later than six months 
after receiving the report. This notice fulfills those requirements.

FOR FURTHER INFORMATION CONTACT: Kate Goodrich (202) 690-7213.

I. Background

    Rising health care costs coupled with the growing concern over the 
level and variation in quality and efficiency in the provision of 
health care raise important challenges for the United States. Section 
183 of MIPPA also required the Secretary of the Department of Health 
and Human Services (HHS) to contract with a consensus-based entity to 
perform various duties with respect to health care performance 
measurement. These activities support HHS's efforts to achieve value as 
a purchaser of high-quality, patient-centered, and financially 
sustainable health care. The statute mandates that the contract be 
competitively awarded for a period of four years and may be renewed 
under a subsequent competitive contracting process.
    In January, 2009, a competitive contract was awarded by HHS to the 
National Quality Forum (NQF) for a four-year period. The contract 
specified that NQF should conduct its business in an open and 
transparent manner, provide the opportunity for public comment and 
ensure that membership fees do not pose a barrier to participation in 
the scope of HHS's contract activities, if applicable.
    The HHS four-year contract with NQF includes the following major 
tasks:
    Formulation of a National Strategy and Priorities for Health Care 
Performance--NQF shall synthesize evidence and convene key stakeholders 
on the formulation of an integrated national strategy and priorities 
for health care performance measurement in all applicable settings. NQF 
shall give priority to measures that: address the health care provided 
to patients with prevalent, high-cost chronic diseases; provide the 
greatest potential for improving quality, efficiency and patient-
centered health care and may be implemented rapidly due to existing 
evidence, standards of care or other reasons. NQF shall consider 
measures that assist consumers and patients in making informed health 
care decision; address health disparities across groups and areas; and 
address the continuum of care across multiple providers, practitioners 
and settings.
    Implementation of a Consensus Process for Endorsement of Health 
Care Quality Measures--NQF shall implement a consensus process for 
endorsement of standardized health care performance measures which 
shall consider whether measures are evidence-based, reliable, valid, 
verifiable, relevant to enhanced health outcomes, actionable at the 
caregiver level, feasible to collect and report, and responsive to 
variations in patient characteristics such as health status, language 
capabilities, race or ethnicity, and income level and is consistent 
across types of providers including hospitals and physicians.
    Maintenance of Consensus Endorsed Measures--NQF shall establish and 
implement a maintenance process to ensure that endorsed measures are 
updated (or retired if obsolete) as new evidence is developed.
    Promotion of Electronic Health Records--NQF shall promote the 
development and use of electronic health records that contain the 
functionality for automated collection, aggregation, and transmission 
of performance measurement information.
    Focused Measure Development, Harmonization and Endorsement Efforts 
To Fill Critical Gaps in Performance Measurement--NQF shall complete 
targeted tasks to support performance measurement development, 
harmonization, endorsement and/or gap analysis.
    Development of a Public Web Site for Project Documents--NQF shall 
develop a public Web site to provide access to project documents and 
processes. The HHS contract work is found at: http://www.qualityforum.org/projects/ongoing/hhs/.
    Annual Report to Congress and the Secretary--Under section 
1890(b)(5)(A) of the Act, by not later than March 1 of each year 
(beginning with 2009), NQF shall submit to Congress and the Secretary 
of HHS an annual report. The report shall contain a description of the 
implementation of quality measurement initiatives under the Act and the 
coordination of such initiatives with quality initiatives implemented 
by other payers; a summary of activities and recommendations from the 
national strategy and priorities for health care performance 
measurement tasks; and a discussion of performance by NQF of the duties 
required under the HHS contract. Section 1890(b)(5)(B) of the Social 
Security Act requires the Secretarial review of the annual report to 
Congress upon receipt and the publication of the report in the Federal 
Register together with any Secretarial comments not later than 6 months 
after receiving the report.
    The first annual report covered the performance period of January 
14, 2009 to February 28, 2009 or the first six weeks post contract 
award. Given the short timeframe between award and the statutory 
requirement for the submission of the first annual report, this first 
report provided a brief summary of future plans. In March 2009, NQF 
submitted the first annual report to Congress and the Secretary of HHS. 
The Secretary published a notice in the Federal Register in compliance 
with the statutory mandate for review and publication of the annual 
report on September 10, 2009 (74 FR 46594).
    In March 2010, NQF submitted to Congress and the Secretary the 
second annual report covering the period of performance of March 1, 
2009 through February 28, 2010. The second annual report was published 
in the Federal Register on October 22, 2010 (75 FR 65340) to comply 
with the statutorily required Secretarial review and publication.
    In March 2011, NQF submitted the third annual report to Congress 
and the Secretary of HHS. This notice complies with the statutory 
requirement for Secretarial review and publication of the third annual 
report covering the period of performance of March 1, 2010 through 
February 28, 2011.
    The Patient Protection and Affordable Care Act of 2010 (ACA) was 
signed into law on March 23, 2011. Section 3014 of this Act included a 
time-sensitive requirement for NQF to provide input into the national 
priorities for consideration under for the National Strategy for 
Quality for Improvement in Healthcare. As a result, one additional 
activity was added to the contract to fulfill this requirement within 
the contract year. The NQF convened the National Priorities Partnership 
and

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developed a consensus report on input to HHS on the development of the 
National Quality Strategy.

II. March 2011--NQF Report to Congress and the HHS Secretary

    Submitted in March 2011, the third annual report to Congress and 
the Secretary spans the period of January 14, 2010 through January 13, 
2011.
    A copy of NQF's submission of the March 2011 annual report to 
Congress and the Secretary of HHS can be found at: http://www.qualityforum.org/projects/hhs/.
    The 2011 NQF annual report is reproduced in section III of this 
notice.

III. NQF March 2011 Annual Report

Advancing Performance Measurement: NQF Report to Congress 2011

Report to the Congress and the Secretary of the U.S. Department of 
Health and Human Services, Covering the Period of January 14, 2010, to 
January 13, 2011 Pursuant to PL 110-275 and Contract HHSM-500-
2009-00010C

NQF Mission
    The National Quality Forum (NQF) operates under a three-part 
mission to improve the quality of American healthcare by:
     Building consensus on national priorities and goals for 
performance improvement and working in partnership to achieve them;
     Endorsing national consensus standards for measuring and 
publicly reporting on performance; and
     Promoting the attainment of national goals through 
education and outreach programs.
    As a private-sector standard-setting body recognized under the 
National Technology Transfer and Advancement Act (Pub. L. 104-113), NQF 
endorses standardized performance measures, serious reportable events, 
and safe practices. NQF also serves as the convener of two multi-
stakeholder partnerships: the National Priorities Partnership, which 
provides guidance on setting national priorities, goals, and strategic 
improvement opportunities; and the Measure Applications Partnership, 
which recommends measures for use in various public reporting, payment, 
and other programs.

Table of Contents

Acknowledgments
Foreword
I. Executive Summary
II. About NQF
III. About the Contract
IV. HHS-Funded Work
V. Looking Forward
    Appendix A: Summary of Accomplishments Under the Contract
    Appendix B: List of Measures Endorsed
    Appendix C: Reports Published by NQF During the Contract Period
    Appendix D: NQF Board of Directors
    Appendix E: NQF Senior Leadership
    Appendix F: National Priorities Partnership
    Appendix G: NQF Consensus Development Process (Version 1.8)
    Appendix H: List of NQF Member Organizations by Council

Foreword

    In 2008, Congress passed the Medicare Improvements for Patients and 
Providers Act (Pub. L. 110-275),\1\ signifying its growing recognition 
of the systemic nature of the nation's healthcare quality issues. The 
Act set bearings for the national healthcare performance improvement 
movement and charted a course for national action, presenting the 
opportunity to unify the nation's disparate healthcare quality 
improvement efforts into a coherent national strategy. Importantly, it 
did not impose top-down direction to achieve its goals. Instead, the 
Act provides guidance and resources for the federal government to work 
with a consensus-based entity to identify priorities and performance 
measures through an open and transparent decision-making process that 
affords an opportunity for all stakeholders to participate.
    On January 14, 2009, the National Quality Forum (NQF) was awarded a 
contract that addresses the Act's Section 183, which calls for the 
Department of Health and Human Services (HHS) ``to contract with a 
consensus-based entity, such as the National Quality Forum,'' to 
achieve many of these quality improvement goals. This contract 
subsequently was modified to accommodate specific work called for under 
the Patient Protection and Affordable Care Act of 2010 (Pub. L. 111-
148).\2\ This report summarizes the work performed under this contract 
between January 14, 2010, and January 13, 2011, the second full year 
that the HHS contract has been in place.
    The first year of the contract was devoted to building 
infrastructure to support healthcare quality. We are pleased to report 
that in the second year of the contract, NQF has leveraged that 
infrastructure to demonstrate real achievements in the areas of the 
identification of priorities and gaps in available performance 
measures; adaptation of more than 100 measures for use in electronic 
health records; and endorsement of 62 new measures. These are concrete, 
measurable, and sustainable accomplishments in the nation's quality 
infrastructure that will translate into more effective performance 
improvement, public reporting, and value-based payment programs. We are 
grateful to the Congress and HHS for their continued support of NQF 
and, more broadly, of the quality enterprise in the United States. 
Their commitment to healthcare quality improvement is thoughtful, 
clear, and unquestioned. We also thank the more than 430 institutional 
members of NQF, the hundreds of experts who volunteer to participate in 
NQF expert panels, and NQF staff, whose efforts have contributed to a 
healthcare system that is becoming, as the Institute of Medicine (IOM) 
envisioned in its ``call to action'' a decade ago, safe, effective, 
patient-centered, timely, efficient, and equitable.

William L. Roper,
Chair, Board of Directors, National Quality Forum.
Janet M. Corrigan,
President and Chief Executive Officer, National Quality Forum.

Notes

    1. U.S. Congress, Medicare Improvements for Patients and 
Providers Act (Pub. L. 110-275), Washington, DC: U.S. Government 
Printing Office: 2008. Available at http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=110_cong_public_laws&docid=f:publ275.110.pdf. Last accessed December 2010.
    2. U.S. Congress, Patient Protection and Affordable Care Act of 
2010 (Pub. L. 111-148), Washington, DC: U.S. Government Printing 
Office; 2010. Available at http://www.gpo.gov/fdsys/pkg/PLAW-111publ148/pdf/PLAW-111publ148.pdf. Last accessed December 2010.

I. Executive Summary

    Key strategies for reforming healthcare include: Publicly reporting 
performance results to support informed consumer decision-making; 
aligning payments with value; rewarding providers for investing in 
health information technology (health IT) and using it to improve 
patient care; and providing knowledge and tools to healthcare providers 
and professionals to help them improve their performance. Foundational 
to the success of all of these efforts is a robust ``quality 
measurement enterprise'' that includes priorities and goals for 
improvement; standardized performance measures; an electronic data 
platform that supports measurement and improvement; use of measures in 
payment, public reporting, health IT investment programs, and other 
areas; and performance improvement initiatives in all healthcare 
settings. Many public- and private-sector organizations have important 
responsibilities in the quality

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measurement enterprise, such as various federal agencies, public and 
private purchasers, measure developers, the National Quality Forum 
(NQF), accreditation and certification entities, various quality 
alliances at the national and community levels, state governments, and 
others.
    Recognizing the widespread and systemic nature of the nation's 
healthcare quality and cost challenges and the need to build the 
nation's quality measurement enterprise, Congress passed the Medicare 
Improvements for Patients and Providers Act (Pub. L. 110-275) in 2008. 
On January 14, 2009, NQF was awarded a contract that addresses the 
Act's Section 183, which calls for the Department of Health and Human 
Services (HHS) ``to contract with a consensus-based entity, such as the 
National Quality Forum,'' to carry out work related to its quality 
improvement goals. On September 20, 2010, this contract was modified to 
accommodate specific work called for under the Patient Protection and 
Affordable Care Act of 2010 (Pub. L. 111-148).\1\ This report 
summarizes the work performed under this contract between January 14, 
2010, and January 13, 2011. Appendix C provides a list of the reports 
produced.
    During the contract period, NQF made important contributions to the 
following quality enterprise functions: setting priorities and goals, 
endorsing performance measures, building an infrastructure to support 
performance measurement using an electronic data platform, and 
providing input to the selection of measures for determining 
``meaningful use'' of health IT.

National Priorities

    Setting national priorities is a critical first step to addressing 
our country's serious safety, quality, and cost challenges. Providers 
cannot measure and improve in all areas at once. Priorities focus 
attention on those areas most likely to produce the greatest return on 
investment in terms of better health and healthcare. National 
priorities, especially when established with input from multiple 
stakeholders, also serve as a starting point for alignment of public- 
and private-sector efforts to improve performance. In 2010, NQF made 
three contributions to national priority-setting initiatives: providing 
guidance to HHS on the proposed National Health Care Quality Strategy, 
identifying a prioritized list of high-impact conditions for Medicare 
beneficiaries, and specifying an agenda for measure development and 
endorsement to fill gaps in available measures.
    The Affordable Care Act calls for HHS to establish a National 
Health Care Quality Strategy and to consult with a consensus-based 
entity to convene a multi-stakeholder group to provide input on 
national priorities for improvement in population health and the 
delivery of healthcare services. When asked to perform this role, NQF 
convened the National Priorities Partnership (NPP), a collaborative 
that now includes 48 leading organizations. In October 2010, NPP 
submitted its report to HHS, recommending eight priority areas for 
national action. These include the original six priorities NPP 
identified in a priority-setting effort in 2008: (1) Patient and family 
engagement, (2) population health, (3) safety, (4) care coordination, 
(5) palliative and end-of-life care, and (6) overuse. They also include 
the addition of two areas of focus: (1) Equitable access to ensure that 
all patients have access to affordable, timely, and high-quality care; 
and (2) infrastructure supports (e.g., health IT) to address underlying 
system changes that will be necessary to attain the goals of the other 
priority areas. NPP also offered aspirational and actionable goals to 
be achieved over the next three to five years for each priority area.

Recommendations of the National Priorities Partnership
[GRAPHIC] [TIFF OMITTED] TN07SE11.000

    Source: National Quality Forum (NQF), Input to the Secretary of 
Health and Human Services on Priorities for the 2011 National Quality 
Strategy, Washington, DC: NQF; 2010. Available at http://www.nationalprioritiespartnership.org/. Last accessed February 2011.

[[Page 55477]]

    Complementing NPP's work, which focused on ``cross-cutting'' areas 
(e.g., care coordination) that affect all or most patients, was the 
work of NQF's Measure Prioritization Advisory Committee, which 
prioritized the top 20 high-impact Medicare conditions that account for 
more than 90 percent of Medicare costs. Improvements in the safety and 
effectiveness of the care processes for these conditions can affect the 
outcomes of millions of Americans and eliminate waste from the health 
system.

Prioritized List of 20 High-Impact Medicare Conditions*

(1) Major depression
(2) Congestive heart failure
(3) Ischemic heart disease
(4) Diabetes
(5) Stroke/transient ischemic attack
(6) Alzheimer's disease
(7) Breast cancer
(8) Chronic obstructive pulmonary disease
(9) Acute myocardial infarction
(10) Colorectal cancer
(11) Hip/pelvic fracture
(12) Chronic renal disease
(13) Prostate cancer
(14) Rheumatoid arthritis/osteoarthritis
(15) Atrial fibrillation
(16) Lung cancer
(17) Cataract
(18) Osteoporosis
(19) Glaucoma
(20) Endometrial cancer

    *As determined by NQF Measure Prioritization Advisory Committee 
under contract to HHS.
    Source: NQF, Prioritization of High-Impact Medicare Conditions and 
Measure Gaps, Washington, DC: NQF; 2010. Available at http://www.qualityforum.org/projects/prioritization.aspx#t=2&s=&p=4%7C. Last 
accessed February 2011.
    Taken together, cross-cutting areas and the prioritized conditions 
provide a two-dimensional framework for performance measurement. The 
current portfolio of NQF-endorsed measures includes many measures 
applicable to these cross-cutting areas and leading conditions, but 
there are important gaps. To advise HHS on how best to focus measure 
development resources on filling these gaps, NQF was asked to construct 
an agenda for measure development and endorsement. In constructing this 
agenda, the NQF Measure Prioritization Advisory Committee also 
considered child health measurement needs and the needs of the broader 
population health community. The final report, Measure Development and 
Endorsement Agenda (January 2011, available at http://www.qualityforum.org/MeasureDevelopmentandEndorsementAgenda.aspx), 
provides prioritized lists of measure gaps in eight areas: (1) Resource 
use/overuse, (2) care coordination and management, (3) health status, 
(4) safety processes and outcomes, (5) patient and family engagement, 
(6) system infrastructure supports, (7) population health, and (8) 
palliative care. As described below, efforts are well underway to fill 
these gaps.

Performance Measures

    The NQF portfolio of endorsed measures includes more than 625 
measures that support the needs of both public- and private-sector 
stakeholders and are appropriate for use in accountability and quality 
improvement programs. The measures fall into the following major 
categories: Measures of patient outcomes (e.g., mortality, 
readmissions, complications, health functioning); care processes 
(measures of adherence to practice guidelines, such as prescribing beta 
antagonists after heart attacks); patient experience (e.g., patient's 
perception of the quality of hospital care); resource use measures 
(e.g., average nursing care hours per patient day); and composite 
measures (e.g., overall indicator of pediatric patient safety 
constructed from measures of adverse events). Although the total number 
of measures is sizable, the number applicable to a given provider 
type--ambulatory practices, emergency services, hospitals, nursing 
homes, home health, rehabilitation services, mental health and 
substance abuse providers, kidney dialysis centers, and health plans--
is more limited. To meet the needs of many, the portfolio also must 
accommodate measures that run off different data platforms (e.g., paper 
records, administrative/claims data, electronic health records) during 
this period of transition to an electronic platform.
    During the contract period, the HHS contract provided support for 
measure endorsement projects in the following areas: Patient outcomes 
for the 20 high-impact Medicare conditions; patient safety, including 
medication safety and healthcare-associated infections; nursing homes; 
child health; and efficiency and resource use. NQF's endorsement 
process, which includes evaluation by technical experts and a multi-
stakeholder panel, as well as extensive public input, requires up to a 
year to complete depending on the volume and complexity of measures. On 
occasion, a project also may be temporarily halted to allow time for 
the measure developers to change measures in response to NQF requests 
(for example, two measures of overuse of neck imaging in trauma 
combined). There were 62 newly endorsed measures resulting from the 
work conducted during the contract period--14 endorsed prior to the 
close of the contract period and another 48 awaiting final ratification 
by the NQF Board (which occurred shortly after the close of the 
reporting period). See Appendix B for a complete list of newly endorsed 
measures.

                Newly Endorsed Measures by Measure Type *
------------------------------------------------------------------------
                                                              Number of
                        Measure type                           measures
------------------------------------------------------------------------
Outcome....................................................           38
Process....................................................            8
Patient Experience.........................................            6
Resource Use...............................................            6
Composite..................................................            4
                                                            ------------
    Total..................................................           62
------------------------------------------------------------------------
* Measures endorsed as a result of HHS contract, 1/14/10 to 2/28/11.

    In addition to endorsing new measures, NQF also oversees the 
updating and maintenance of currently endorsed measures. As a condition 
of maintaining endorsement, measure developers are required to update 
their measures to reflect changes in the evidence base. NQF-endorsed 
measures undergo a comprehensive re-evaluation every three years and 
must recompete ``head-to-head'' with any new or existing measures for 
``best-in-class'' determination. During the contract period, NQF began 
maintenance of the 47 cardiovascular measures and 44 surgical measures 
in its portfolio.
    NQF also analyzed the implications of the transition from the 
International Classification of Disease, Ninth Revision, Clinical 
Modification (ICD-9-CM) to the International Classification of 
Diseases, Tenth Revision, Clinical Modification and Procedure Coding 
System (ICD-10-CM/PCS) for quality measurement. As explained in the 
final report, ICD-10 CM/PCS Coding Maintenance Operational Guidance 
(October 2010, available at http://www.qualityforum.org/publications/2010/10/ICD-10-CM/PCS_Coding_Maintenance_Operational_Guidance.aspx), this transition planned for 2013 has significant 
implications for measure developers, as the majority of NQF-endorsed 
measures are specified using ICD-9-CM codes.

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Technical Infrastructure To Support Measurement Using an Electronic 
Platform

    The American Recovery and Reinvestment Act of 2009 provides $20 
billion for investment in health IT and use of that technology to 
improve patient care. Health IT has the potential to lead to care that 
is safer, more effective, more affordable, and better coordinated. But 
to get there, electronic health records (EHRs) and other tools must 
capture the right data to support performance measurement, and 
performance measures must be specified to run on an electronic 
platform. NQF contributions in this area fall into four categories: (1) 
Development of a Quality Data Model (QDM) that defines the data that 
must be captured in EHRs and personal health records to support quality 
measurement and improvement; (2) development of a standard form and an 
automated tool for measure developers to create eMeasures that can 
readily be incorporated into vendors' health IT systems; (3) re-
specification of 113 performance measures for use with EHRs (i.e., 
eMeasures); and (4) identification of the types of measures that might 
be used to ascertain whether EHRs are being used properly by clinicians 
and to detect any unintended consequences.
    The QDM classifies and describes the information needed for quality 
measurement in a way that health IT vendors understand what data 
elements to capture (including the most reliable source of the data and 
the point in time in the care process when it should be recorded), and 
measure developers know how to specify eMeasures so they will pull the 
correct information from the EHR. Although the QDM was created in 2009, 
NQF's Health Information Technology Advisory Committee made important 
enhancements covered under this contract, such as the development of a 
comprehensive framework for evolving the model that will accommodate 
the data needs of new types of measures (e.g., measures of patient 
engagement in decision-making, long-term functional outcomes, measures 
that incorporate data on social determinants of health), and updates to 
data type definitions and elements. The NQF Clinical Decision Support 
(CDS) Expert Panel also developed a taxonomy of CDS rules and data 
elements that paves the way for CDS developers to use the QDM in 
specifying clinical decision support rules (see Driving Quality and 
Performance Measurement--A Foundation for Clinical Decision Support at 
http://www.qualityforum.org/Publications/2010/12/Driving_Quality_
and_Performance_Measurement__-A_Foundation_for_Clinical_
Decision_Support.aspx).
    To facilitate the specification of eMeasures in a standardized 
fashion concordant with the QDM, NQF developed a standardized eMeasure 
format to be used by the more than 50 measure developers. The QDM and 
eMeasure format taken together will yield important benefits in future 
years, such as:
     Reduced health IT costs: Health IT vendors will be able to 
identify the data requirements for all the measures in the portfolio of 
NQF-endorsed measures and will be able to readily incorporate eMeasures 
from any measure developer in almost a ``turnkey'' fashion.
     Reduced measure development, testing, and maintenance 
costs: Performance measures generally include common components, such 
as denominators, numerators, exclusions, and sometimes risk-adjustment 
algorithms. Measure developers may be able to share and reuse certain 
components of measures (e.g., code sets and rules for identifying 
patients with Type 2 diabetes on insulin).
     More useful performance information: When developers 
harmonize measures and make use of common definitions and conventions 
for specifying eMeasures, providers can readily combine measures from 
different developers into their performance improvement initiatives 
without introducing ``noise'' into the performance results.
    The eMeasure format now is being converted into a software tool 
known as the Measure Authoring Tool, which will be tested in 2011. NQF 
will provide training on using the tool to measure developers and 
others.
    The foundational work on the QDM and the eMeasure format conducted 
in 2009 and 2010 under the contract was critical to the accomplishment 
of another important objective--the re-specification of 113 measures 
from paper-based format to eMeasure format. In response to an HHS 
request to develop eSpecifications for measures currently being used by 
HHS for public reporting, payment, quality improvement, or other 
purposes, NQF worked in coordination with the 18 developers of these 
measures to convert the measures from their current format into the 
eMeasure format. These eMeasures, along with detailed specifications, 
can be found on the NQF Web site at http://www.qualityforum.org/Projects/e-g/eMeasures/Electronic_Quality_Measures.aspx?section=PublicandMemberComment2011-02-012011-04-01. HHS 
is using many of the re-specified measures to assess meaningful use of 
health IT for purposes of awarding incentive payments in 2011.
    The fourth and final area of NQF's health IT work focused on 
answering the question, ``How will we know if health IT is being 
properly used by clinicians to provide better care?'' To achieve the 
full potential of health IT to enhance the safety, effectiveness, and 
affordability of care, clinicians must use the technology as intended. 
For example, reductions in medication errors will be achieved only if 
clinicians do not disable or ignore alerts for potential drug 
interactions. In the report Driving Quality--A Health IT Assessment 
Framework for Measurement (2010, available at http://
www.qualityforum.org/Publications/2010/12/Driving_Quality__-A_
Health_IT_Assessment_Framework_for_Measurement.aspx), NQF 
identifies potential types of measures that might be developed and 
incorporated into EHRs to provide information on when and how the 
technology is being employed by front-line providers, which in turn can 
be used to determine if there is a need for more user-friendly 
interfaces, modifications in work flow, or clinician education and 
training programs. The report also identifies types of measures that, 
if incorporated into EHRs, would provide early warning signs of 
unintended consequences (e.g., selection of an inappropriate order set 
based on the patient's active diagnoses).

Measure Selection for Applications

    Setting National Priorities and Goals serves as an important 
starting point for selecting measures, but for most applications there 
are additional considerations. In response to a request from the Office 
of the National Coordinator for Health IT (ONC), NQF prepared a ``quick 
turnaround'' report in the summer of 2010 to assist HHS leadership and 
the Health IT Policy Committee in identifying a parsimonious set of 
measures that might be used in 2013 to assess meaningful use of health 
IT. The NQF report Identification of Potential 2013 e-Quality Measures 
(August 2010, available at http://www.qualityforum.org/projects/i-m/meaningful_use/meaningful_use.aspx), finalized in August 2010, used 
the six national priorities identified by NPP as an organizing 
framework; proposed five criteria that have been utilized to identify 
measures in each priority area; and based on a review of measures in 
the NQF portfolio and an environmental

[[Page 55479]]

scan of measures used by leading health systems, identified available 
measures that might be adapted for use in 2013 and beyond.

Summary

    This is an extraordinary period of challenges and opportunities for 
our country's healthcare system. Reforming the healthcare delivery 
system to provide care that is safe, effective, and affordable 
necessitates changes in the environment of care. As the Institute of 
Medicine noted a decade ago in its landmark report Crossing the Quality 
Chasm, public reporting, value-based payment, a national health 
information network, and programs for dissemination of knowledge and 
tools are key elements of creating an environment of care that enables 
and rewards improvement.
    Fundamental building blocks for all of these efforts are a vigorous 
quality measurement enterprise including national priorities that focus 
our efforts on high-leverage areas with the greatest potential to 
produce better health and healthcare; the ability to measure, report, 
and reward performance results; and the ability to share best 
practices. Building such an enterprise is a shared responsibility of 
many stakeholders in the public and private sector. NQF is thankful for 
the opportunity to contribute.

    Note: 1. U.S. Congress, Patient Protection and Affordable Care 
Act of 2010 (Pub. L. 111-148), Washington, DC: U.S. Government 
Printing Office; 2010. Available at http://www.gpo.gov/fdsys/pkg/PLAW-111publ148/pdf/PLAW-111publ148.pdf. Last accessed December 
2010.

II. About the National Quality Forum

    NQF was created in 1999 as a national standard-setting organization 
for healthcare performance measures. NQF is governed by a Board of 
Directors that includes healthcare leaders from the public and private 
sectors, with a majority of its at-large seats held by consumers and 
those who purchase services on consumers' behalf. A multi-stakeholder 
organization, NQF's more than 430 members are organized into eight 
councils--consumers; purchasers; healthcare professionals; health 
plans; provider organizations; public/community health agencies; 
quality measurement, research, and quality improvement organizations; 
and suppliers and industry--thus drawing on the expertise and insight 
of every sector of the healthcare field.
    In establishing national consensus standards, NQF adheres to the 
National Technology Transfer and Advancement Act of 1995 (Pub. L. 104-
113) \1\ and the Office of Management and Budget's formal definition of 
consensus.\2\ NQF endorses performance measures, preferred practices, 
serious reportable events, and measurement frameworks through its 
formal Consensus Development Process (CDP),\3\ which provides for 
extensive multi-stakeholder input. The strict adherence to this CDP 
qualifies NQF as a voluntary consensus standards-setting organization, 
granting its endorsed measures special legal standing.

NQF Consensus Development Process

1. Call for Intent to Submit Candidate Standards
2. Call for Nominations
3. Call for Candidate Standards
4. Candidate Consensus Standard Review
5. Public and Member Comment
6. Member Voting
7. Consensus Standards Approval Committee (CSAC) Decision
8. Board Ratification
9. Appeals

    The NQF portfolio of voluntary consensus standards includes 
performance measures, serious reportable events, and preferred 
practices (i.e., safe practices). A complete list of measures included 
in the NQF portfolio can be found at http://www.qualityforum.org/Measures_List.aspx. There are measures applicable to nearly all 
healthcare settings (e.g., ambulatory settings, hospitals, nursing 
homes, home health agencies, health systems) and types of clinicians 
(e.g., primary care providers, specialists). NQF uses a two-dimensional 
framework to organize the measures in its portfolio:
     Cross-cutting areas: measures that affect all or most 
patients, such as safety, care coordination, and overuse; and
     Clinical areas: measures that apply to patients with 
specific conditions, such as diabetes, asthma, or congestive heart 
failure.
    Approximately one-third of the measures in NQF's portfolio are 
measures of patient outcomes (e.g., mortality, readmissions, health 
functioning, depression screening tool that assesses emotional status 
and social engagement), or experience of care (e.g., satisfaction). 
Most of the remaining measures are measures of care processes that can 
be linked to better outcomes (e.g., medication reconciliation, annual 
eye and foot exam for patients with diabetes). Approximately 20 percent 
of endorsed measures relate to the important area of patient safety. 
The NQF-endorsed Safe Practices for Better Healthcare provide an 
evidence-based approach to improving patient safety.
    The measures included in the NQF portfolio are owned or sponsored 
by 53 different stewards, which include: Public agencies (e.g., the 
Centers for Medicare & Medicaid Services [CMS], the Agency for 
Healthcare Research and Quality), state and community entities (e.g., 
Minnesota Community Measurement), professional societies (e.g., 
Physician Consortium for Performance Improvement convened by the 
American Medical Association, Society of Thoracic Surgeons), 
accrediting organizations (e.g., the National Committee for Quality 
Assurance, The Joint Commission), health plans, academic and research 
institutions, health systems, and others. The portfolio has become a 
rich resource for national, state, and community-level initiatives that 
seek the best performance measures to use in public reporting, payment, 
and quality improvement initiatives.
    In recent years, NQF has worked closely with the Department of 
Health and Human Services (HHS) and measure stewards to re-specify 
performance measures for use with interoperable electronic health 
records (EHRs) and personal health records. To date, more than 110 
measures have been ``retooled.'' HHS currently uses these retooled 
measures for activities including ``meaningful use'' measurement in the 
Electronic Health Records Incentive Programs, the Medicare Hospital 
Compare public reporting program, and in various value-based payment 
programs. NQF has encouraged measure stewards to adopt common 
conventions in specifying eMeasures and in identifying the types of 
data that must be captured in electronic health records to support 
quality measurement and improvement.
    In addition to its role as a standard-setting body, NQF also serves 
as the neutral convener of two national multi-stakeholder partnerships. 
The National Priorities Partnership (NPP) was established in 2007 to 
set national priorities and goals for performance improvement and 
released its first report shortly thereafter identifying six original 
major priority areas: (1) Patient and family engagement, (2) population 
health, (3) patient safety, (4) care coordination, (5) palliative and 
end-of-life care, and (6) overuse. NPP currently consists of 42 leading 
private-sector organizations--including consumers, purchasers, health 
plans, providers, health professionals, accreditation/certification 
bodies--and six Federal agencies. These NPP leaders have worked closely 
over the past three years

[[Page 55480]]

to identify priorities for healthcare quality improvement and to engage 
a broad group of stakeholders in coalescing around these priorities to 
drive change. In September 2010, in response to a request from HHS, NPP 
provided input regarding priorities for the 2011 HHS National Quality 
Strategy.\4\ A second multi-stakeholder partnership is the Measure 
Applications Partnership (MAP). This very new group, still in the 
formative stages, will be convened for the first time in 2011 to 
provide input to HHS on the selection of measures for use in various 
public reporting and payment programs.
    In recent years, NQF also has enhanced its health information 
technology portfolio to contribute to the creation of an interoperable 
electronic infrastructure that supports quality measurement and 
improvement. This began with NQF's construction of the Quality Data 
Model (QDM), a classification system that describes clinical and other 
information used for quality measurement and provides a standardized 
terminology to be used in constructing eMeasures. NQF also is working 
on a Measure Authoring Tool to help measure developers build eMeasures.

Notes

    1. U.S. Congress, National Technology Transfer and Advancement 
Act of 1995 (PL 104-113), Washington, DC: U.S. Government Printing 
Office, 1995. Available at http://standards.gov/standards_gov/nttaa.cfm. Last accessed December 2010.
    2. The White House, U.S. Office of Management and Budget. 
Circular No. A-119, February 10, 1998, Washington, DC: U.S. Office 
of Management and Budget, 1998. Available at http://www.whitehouse.gov/omb/circulars_a119/. Last accessed December 
2010.
    3. National Quality Forum (NQF), NQF Consensus Development 
Process, v. 1.8. Available at http://www.qualityforum.org/Measuring_Performance/Consensus_Development_Process.aspx. Last 
accessed December 2010.
    4. National Priorities Partnership. Input to the Secretary of 
Health and Human Services on Priorities for the 2011 National 
Quality Strategy. Washington, DC: NQF; 2010. Available online at 
http://www.nationalprioritiespartnership.org/uploadedFiles/NPP/Non-Partners/Newsletters/NPP%20Input%20to%20HHS%20on%20Priorities%20for%202011%20National%20Quality%20Strategy_Final%20Report%282%29.pdf. Last accessed February 
2011.

III. About the Contract

    The Medicare Improvements for Patients and Providers Act of 2008 
(Pub. L. 110-275) is a wide-ranging law that addresses many aspects of 
Medicare and Medicaid, including the addition of new benefits for 
Medicare beneficiaries. Among other things, the Act directs the 
Secretary of HHS to contract with a consensus-based entity for certain 
activities relating to healthcare performance measurement.
    On January 14, 2009, NQF was awarded a contract, HHSM-500-2009-
00010C, under the Act's Section 183. This contract is administered by 
HHS's Office of the Assistant Secretary for Planning and Evaluation 
(ASPE), which provides strategic leadership and technical and 
management oversight for the contract, and by CMS, which provides 
technical input and operational support. The contract provided up to 
$10 million for the first year after award, with the option for three 
$10 million annual renewals through 2012. It calls for NQF to:
     Develop a prioritized list of conditions that impose a 
heavy health burden on beneficiaries and account for significant costs;
     Identify and endorse measures that various stakeholders 
can use to assess and improve the care provided to beneficiaries with 
these conditions, and the performance of providers in various 
healthcare settings;
     Identify programs to track and disseminate measures;
     Ensure performance measures are regularly and 
appropriately updated and remain relevant for public reporting and 
improvement;
     Promote the use of EHRs for performance measurement, 
reporting, and improvement; and
     Report annually to Congress on the status of the project 
and progress to date.
    This contract had the effect of providing a mandate and stable 
funding to NQF, granting the organization a source of core funding to 
pursue this important work in a coordinated, strategic manner. While 
the work conducted under the contract is intended specifically to 
benefit all those served by HHS programs, it will have the salutary 
additional benefit of improving care for all Americans. The work being 
conducted under this contract directly relates to NQF's core 
competencies in three areas:
     Building consensus on National Priorities and Goals: NQF 
has convened leaders from major stakeholder groups and through this 
process has identified National Priorities and Goals for Performance 
Improvement. This work provides a foundation for the priority-setting 
efforts under this contract, which focus on clinical conditions. The 
priorities identification work served as a guide for measure gap 
analysis and informs work going forward that will result in a 
harmonized portfolio of high-leverage measures.
     Endorsing performance measures: NQF has endorsed more than 
625 performance measures and preferred practices under its formal CDP, 
granting those measures and practices special legal standing as 
voluntary consensus standards, working toward a goal of achieving a 
comprehensive yet parsimonious set of performance measures that map to 
national priorities and fill critical gaps.
     Facilitating the development of performance measures 
specified for use with electronic health records and personal health 
records, referred to as eMeasures: NQF has worked to identify the types 
of information that need to be included in an EHR to enable electronic 
reporting on quality metrics and has coordinated the efforts of measure 
developers to retool 113 measures for use on an electronic platform.
    Under the contract, HHS asked that performance measures focus on 
``outcomes and efficiencies that matter to patients, align with 
electronic collection at the front end of care, encompass episodes of 
care when possible, and will be attributable to providers where 
possible.''
    The work under this contract is divided into 13 tasks. Six of the 
tasks are procedural--involving an opening meeting, the development of 
a work plan, the development and implementation of a quality assurance 
Internal Evaluation Plan, weekly conference calls, monthly progress 
reports, and the creation of this annual report. The remaining seven 
call for specific deliverables and are the focus of this report.
    Task 6 is the formulation of a national strategy and priorities for 
healthcare performance measurement. Task 7 is the implementation of a 
consensus process for endorsing healthcare quality measures. This task 
includes an evaluation of NQF's consensus development process and the 
conduct of endorsement projects focusing on known measure gap areas. 
Task 8 is the maintenance of previously endorsed NQF measures. Task 9 
is the promotion of EHRs. Task 11 is the development of a public Web 
site for project documents. Task 12 calls for measure development, 
harmonization, and endorsement efforts to fill critical gaps in 
performance measurement. In 2010, Congress passed the Patient 
Protection and Affordable Care Act of 2010 (Pub. L. 111-148), which 
directed HHS to contract with a consensus-based entity to provide 
multi-stakeholder input into the National Quality Strategy, as well as 
the

[[Page 55481]]

selection of measures for use in various programs by CMS and, 
potentially, other federal agencies. This contract was modified to 
perform additional work under Section 3014 of the Affordable Care Act. 
That work, Task 13, was the convening of the NPP to advise the 
Secretary of HHS on the development of the National Quality Strategy.
    Details of work performed under the HHS contract in each of these 
tasks are found in Section IV of this report.

IV. HHS-Funded Work

    This section describes details of work performed under each task 
according to the HHS contract in 2010. Appendix A is a summary of the 
accomplishments under the contract. Appendix C is a list of all final 
reports produced with links to where they can be found on the NQF Web 
site.

National Strategy and Priorities (Task 6)

    Forming a strategy and setting priorities for performance 
improvement is crucial to focusing resources on areas that will produce 
the greatest improvements in terms of better health and healthcare. In 
2007, NQF convened NPP, co-chaired by Margaret O'Kane, president of the 
National Committee for Quality Assurance, and Bernard Rosof, MD, chair 
of the Physician Consortium for Performance Improvement convened by the 
American Medical Association. In work predating this contract, NPP 
identified six priorities as those with the greatest potential to 
eradicate disparities, reduce harm, and remove waste from the American 
healthcare system. In its recent report to the Secretary, NPP added two 
additional priorities. (See Task 13.)
    Building upon this foundation, in work funded under this contract, 
NQF undertook the following projects:
     Prioritizing high-impact Medicare conditions and 
associated measure gaps (Task 6.0);
     Setting a national measure development and endorsement 
agenda (Task 6.2);
     Analyzing measures targeted under the Meaningful Use 
portion of the Medicare Electronic Health Record Incentive Program, 
specifically examining how health IT tools can improve the efficiency, 
quality, and safety of healthcare delivery (Task 6.4);
     Investigating the use of NQF-endorsed measures (Task 6.1); 
and
     Analyzing measures being used to gauge quality of care for 
people with multiple chronic conditions (Task 6.3).
Prioritization of Medicare High-Impact Conditions
    In May 2010, NQF published Prioritization of High-Impact Medicare 
Conditions and Measure Gaps.\1\ This report was based on the work of 
NQF's Measure Prioritization Advisory Committee, which prioritized the 
top 20 high-impact Medicare conditions \2\ that account for more than 
90 percent of Medicare costs (see below). The committee considered 
multiple dimensions in its analysis, including: cost; prevalence; the 
potential for improving quality, efficiency, and patient-centeredness; 
the potential for reducing overuse and waste; variability in provider 
performance and care delivery; and disparities. In related work under 
this contract, NQF is endorsing outcome measures for these 20 high-
impact conditions. (See Task 7.1.)

Prioritized List of 20 High-Impact Medicare Conditions*

(1) Major depression
(2) Congestive heart failure
(3) Ischemic heart disease
(4) Diabetes
(5) Stroke/transient ischemic attack
(6) Alzheimer's disease
(7) Breast cancer
(8) Chronic obstructive pulmonary disease
(9) Acute myocardial infarction
(10) Colorectal cancer
(11) Hip/pelvic fracture
(12) Chronic renal disease
(13) Prostate cancer
(14) Rheumatoid arthritis/osteoarthritis
(15) Atrial fibrillation
(16) Lung cancer
(17) Cataract
(18) Osteoporosis
(19) Glaucoma
(20) Endometrial cancer

    * As determined by NQF Measure Prioritization Advisory Committee 
under contract to HHS.
Measure Development and Endorsement Agenda
    The work on prioritization of conditions fed directly into a 
related project under this task--the creation of a measure development 
and endorsement agenda. This prioritization project provides guidance 
on how best to invest measure development resources and will assist NQF 
in helping the portfolio of endorsed measures evolve to be most useful 
for public reporting, performance-based payment, and quality 
improvement.
    The Measure Prioritization Advisory Committee considered the 
performance measure needs of Medicare, child health, and population 
health. Key objectives included alignment with the measures needed for 
new approaches to public reporting and payment in the Affordable Care 
Act and for the meaningful use provisions in the American Recovery and 
Reinvestment Act of 2009 (Pub. L. 111-5). The Measure Prioritization 
Advisory Committee considered the following: priorities for improvement 
previously identified by NPP; priorities identified by measure 
developers; key areas identified during health information technology 
meaningful use deliberations; disparities-sensitive measure gaps; and 
gaps identified during previous NQF endorsement activities. The final 
report, Measure Development and Endorsement Agenda (published in 
January 2011 and available at http://www.qualityforum.org/MeasureDevelopmentandEndorsementAgenda.aspx#t=2&s=&p=4%7C), provides 
prioritized lists of measure gaps in eight areas:
     Resource use/overuse,
     Care coordination and management,
     Health status,
     Safety processes and outcomes,
     Patient and family engagement,
     System infrastructure supports,
     Population health, and
     Palliative care.
Measures for Meaningful Use
    In spring 2010, HHS's Office of the National Coordinator for Health 
Information Technology (ONC) requested a rapid analysis of the types of 
measures that might be selected to assess meaningful use of health 
information technology (health IT) in 2013 and a preliminary scan of 
whether such measures currently are available or could be developed, 
tested, and endorsed within the requisite timeframe. This project, 
which became Task 6.4 under the HHS contract, provided a framework for 
considering various types of measures and an inventory of available 
EHR-based measures from leading sources. A report, Identification of 
Potential 2013 e-Quality Measures, which was published in August 2010, 
used the six national priorities identified by NPP as an organizing 
framework; proposed five criteria that the Health IT Policy Committee 
and HHS leadership could use to identify a parsimonious set of measures 
in each priority area; and, based on a review of measures in the NQF 
portfolio and an environmental scan of measures used by leading health 
systems, identified available measures that might be adapted for use in 
2013. The report also identified potential methodological issues that 
need to be

[[Page 55482]]

addressed before further measure adaptation or de novo measure 
development.
    NQF also began two projects under this task order that are 
currently in process: measure use evaluation (Task 6.1) and the 
development of an endorsed performance measurement framework for 
patients with multiple chronic conditions (Task 6.3). For evaluating 
uses of NQF-endorsed measures, NQF has engaged RAND to conduct an 
independent, third-party assessment on uptake of endorsed measures for 
such purposes as payment, public reporting, quality improvement, and 
accreditation/certification, as well as to examine success factors and 
implementation barriers. To support the development of a performance 
measurement framework for patients with multiple chronic conditions, 
NQF is in the process of engaging researchers to draft a white paper 
highlighting key measurement-related issues for these patients. A 
multi-stakeholder committee will consider that input and recommend a 
measurement framework. The framework will inform future work pertaining 
to the endorsement of measures of performance for patients with 
multiple chronic conditions.

Implementation of a Consensus Process for the Endorsement of Quality 
Measures (Task 7)

    Valid, meaningful measures of performance make it possible to gauge 
the quality of healthcare and focus quality improvement efforts by 
helping identify what is working and what needs additional improvement. 
Stakeholder-based endorsement of performance measures via a formal 
endorsement process has long been NQF's stock in trade. This task 
involves both a formal evaluation of the endorsement process and a set 
of consensus projects focused on known measure gap areas.
    In the past year, NQF has engaged in several HHS-funded measure 
endorsement projects and related projects. These have included:
     Measures of performance on healthcare outcomes (Task 7.1);
     Measures of patient safety and other projects specifically 
related to patient safety (Task 7.3);
     Measures of performance on palliative care (Task 7.4);
     Measures of performance in nursing homes (Task 7.5);
     An evaluation of NQF's consensus development process, with 
an eye toward making the process more efficient and user friendly (Task 
7.6); and
     Measures of performance of care delivered to children 
(Task 7.8).
Outcome Measures Project
    NQF's outcome measures project focused on areas with the greatest 
potential impact, including common conditions, gaps in measurement of 
patient-focused outcomes, and transitions across care settings. The 
first two cycles of this three-cycle project concentrated on the 
Medicare 20 high-impact conditions list, while the third cycle focused 
on child and mental health. A significant amount of this work has been 
completed, resulting in the endorsement of 35 outcome measures.

------------------------------------------------------------------------
      Outcome measures endorsed as a result of the HHS        Number of
                 contractcross-cutting area                    measures
------------------------------------------------------------------------
Care Coordination..........................................            6
Functional Status..........................................            2
Healthcare System (readmissions, length of stay)...........            3
Patient Experience and Engagement..........................            2
Safety (complications, adverse events).....................           18
Social Determinants........................................            4
------------------------------------------------------------------------

Patient Safety
    Under the HHS contract in 2010-2011, NQF engaged in four 
significant patient safety activities:
     Serious Reportable Events in Healthcare: NQF's work in 
this area dates from 2002, when it published its first report listing 
27 events that are avoidable and have serious consequences for 
patients. The project's objective was to establish consensus among 
consumers, providers, purchasers, researchers, and other healthcare 
stakeholders about those preventable adverse events that should not 
occur and to define them in a way that, should they occur, it would be 
clear what had to be reported. This report was updated in 2006, with 
one additional event being added. Serious Reportable Events has become 
the foundation of HHS's program of denial of payment for certain 
hospital-acquired conditions and for many state-based adverse event 
reporting initiatives. Under the HHS contract, NQF is reviewing the 
Serious Reportable Events, which originally focused on the hospital 
setting, with an eye toward expanding the list of events and their 
reach to three new environments of care: ambulatory practice settings 
(specifically, office-based physician practices); long-term care 
settings (specifically, skilled nursing facilities); and office-based 
surgery centers. The list of events also is being expanded to include 
events that are ``largely preventable'' in addition to those that are 
entirely preventable. The public comment period for the 29 updated and 
proposed new Serious Reportable Events has closed, and NQF expects to 
finalize its revision in spring 2011.
     Patient safety measures: Currently a multiphase project is 
underway to identify and endorse patient safety measures. These include 
measures on medication safety and preventing healthcare-associated 
infections. Final endorsement of these measures and completion of this 
project are slated for spring 2011.
     Public reporting framework for patient safety: Under the 
HHS contract, NQF in 2010 completed a consensus development project 
that resulted in the endorsement of a framework for public reporting of 
patient safety event information. The intention is for reporting 
entities to use this framework, National Voluntary Consensus Standards 
for Public Reporting of Patient Safety Event Information, to create a 
more uniform approach to public reporting.
     Improving patient safety through state-based reporting in 
healthcare: To date, 26 states and the District of Columbia have 
enacted reporting systems to help practitioners identify and learn from 
major adverse events. The majority of those states incorporate at least 
some portion of the NQF list of Serious Reportable Events to help 
establish a more uniform set of criteria by which to report. There 
remains incongruity among states, however, in the use, implementation 
approaches, and perspectives toward reporting a variety of patient 
safety events and, in turn, efforts for improving adverse outcomes from 
these events. Under the contract, NQF has developed an ongoing effort 
to engage representatives of states with reporting systems to 
facilitate communication and inform NQF about successes, barriers, and 
unintended consequences within adverse event reporting at the state 
level, including use of NQF's Serious Reportable Events.
Palliative Care
    Hospice and palliative care services offer physical, emotional, and 
spiritual care to patients coping with severe or end-of life-illnesses. 
These programs also help coordinate care of multiple specialists to 
ensure pain is alleviated and help patients and their families make 
difficult decisions regarding treatment goals. Unfortunately, more than 
1 million people die each year without ever having access to these 
important services. Many of those lacking adequate access will endure

[[Page 55483]]

prolonged and needless suffering and ineffective treatments.
    In 2006, NQF endorsed a framework and preferred practices for 
palliative and hospice care quality.\3\ NPP has identified palliative 
care as a priority area for national action. In 2010, NQF began 
planning for a project that would seek to endorse performance measures 
to gauge the quality of palliative and end-of-life care. This project 
is slated to begin in early 2011.
Nursing Homes
    NQF was an early pioneer in advancing measures of nursing home care 
quality, endorsing an initial set of performance measures in this area 
in 2004.\4\ Building on this work, in 2009 NQF initiated a project to 
consider additional performance measures for chronic and post-acute 
care nursing facilities. The measures evaluated were intended to 
provide tools for regulators, purchasers, and consumers to evaluate the 
quality of care in these facilities, as well as metrics facilities can 
use to assess and improve the quality of care they provide. As a result 
of this project, 21 measures were endorsed. These measures evaluate the 
resident's physical and clinical conditions and abilities, as well as 
preferences and life care wishes. Appendix B provides information on 
these measures.
Evaluation of the Consensus Development Process
    NQF uses its formal endorsement process to evaluate and endorse 
consensus standards, including performance measures, preferred 
practices, frameworks, and reporting guidelines. The process is 
designed to call for input and carefully consider the interests of 
stakeholder groups from across the healthcare industry. (For details on 
how the process works, please see Appendix G.) Because NQF uses this 
formal process, it is recognized as a voluntary consensus standards-
setting organization as defined by the National Technology Transfer and 
Advancement Act of 1995 and Office of Management and Budget Circular A-
119.
    Just as NQF asks the healthcare system to measure, report, monitor, 
and constantly improve, the organization expects constant improvement 
of its own systems, policies, and processes. Thus, under the HHS 
contract in 2010, NQF engaged subcontractor Mathematica Policy 
Research, Inc., to evaluate its consensus process. This comprehensive 
analysis included a technical process analysis, stakeholder analysis, 
and scan of comparative alternatives. The reviewers found that the NQF 
consensus process is generally well regarded among its stakeholders; 
nevertheless, they did suggest specific refinements of the process's 
timeliness, efficiency, and effectiveness. The final report, Assessment 
of the National Quality Forum's Consensus Development Process, was 
submitted to NQF in December. In response to the recommendations, NQF 
already has identified some refinements to the process as described in 
NQF Consensus Development Process 2010--A Year in Review and is 
considering how to refine its consensus process further.
Child Health Measures
    Child health quality is an important, underemphasized area of 
measure development and endorsement. To date, NQF has endorsed more 
than 70 pediatric and perinatal measures, with emphasis in the areas of 
perinatal and neonatal care, chronic illness care, and care for 
hospitalized children. However, the need for child health quality 
measures has outpaced the number of available endorsed measures. The 
recent release of an initial core set of measures for Medicaid and CHIP 
(Children's Health Insurance Program) voluntary use provides an 
important step in assessing child health quality by state programs. The 
Agency for Healthcare Research and Quality National Advisory Council 
Subcommittee on Children's Healthcare Quality Measures for Medicaid and 
CHIP Programs (AHRQ SNAC) has identified a number of child health 
priority areas without adequate measures, including mental health and 
substance abuse services, other specialty services, and inpatient care.
    To assist in these efforts, NQF has embarked on a consensus project 
to endorse additional measures of child health quality in a project 
that will complement the AHRQ SNAC collaboration with CMS, CHIP, and 
Survey and Certification. While the initial core set of Children's 
Health Insurance Program Reauthorization Act (CHIPRA) measures will be 
specified by the Secretary of HHS, there may be other appropriate 
measures that could enhance the portfolio of child health quality 
measures and could be used in the future for the pediatric quality 
measurement program as required by CHIPRA. NQF's current project in 
this area targets measures that could be used in public reporting at 
the population level (e.g., state) and for certain conditions or cross-
cutting areas applicable to the Medicaid population. This project is 
expected to be completed in summer 2011.

Maintenance of Previously Endorsed NQF Measures (Task 8)

    NQF endorsed its first performance measures in 2001. Since then, 
much has changed about healthcare, performance measurement, the 
technologies supporting patient care and documentation (which enable 
performance measurement and reporting), and the NQF endorsement process 
itself. The science supporting quality measurement and medicine itself 
is rapidly evolving, and, of particular note, the science and 
technology of care delivery have changed. It is critically important 
that NQF keep pace with these changes. Simply put, it is unreasonable 
and counterproductive to all parties to gauge performance based on 
anything other than the most up-to-date, best-in-class measures.
    NQF has endorsed more than 625 measures. Ensuring these measures 
remain up to date--a process known as ``measure maintenance''--is a 
time-consuming and resource-intensive task, but a necessary one. 
Endorsed measures must be re-evaluated against NQF's measure evaluation 
criteria \5\ and reviewed alongside newly submitted (but not yet 
endorsed) measures. This head-to-head comparison of new and previously 
endorsed measures fosters harmonization (please see Task 12.2 for a 
description of harmonization) and helps ensure NQF is endorsing the 
best available measures.

                     NQF Measure Maintenance Cycles
------------------------------------------------------------------------
           CYCLE A-1                  CYCLE B-1            CYCLE C-1
------------------------------------------------------------------------
Cardiovascular-1...............  Cancer               Healthcare
                                                       infrastructure
Surgery-1......................  Pulmonary/critical   HEENT
                                  care
Prevention.....................  Safety-1             Infectious disease
Cardiovascular-2...............  Disparities          Neurology
Surgery-2......................  Palliative and end-  Patient experience
                                  of-life care         and engagement
Endocrine......................  Perinatal            Functional status

[[Page 55484]]

 
GU/GYN.........................  Renal                GI
Mental health..................  Care coordination    ..................
Musculoskeletal................  Safety-2             ..................
------------------------------------------------------------------------

    Under the HHS contract in 2010, NQF finalized a process for the 
systematic, complete maintenance of all of its endorsed measures. This 
process involves reviewing all endorsed measures across 22 topic areas 
every three years. The numbers of topic areas and measures are subject 
to change in the future depending on the type and volume of new 
measures received in upcoming projects. NQF also began work using this 
new endorsement maintenance process on two major areas for measure 
maintenance: Cardiovascular and surgery measures. These projects are 
scheduled for completion later in 2011.

Promotion of Electronic Health Records (Task 9)

    The opportunity to improve healthcare through health IT has never 
been greater. The American Recovery and Reinvestment Act of 2009 
provides a $20 billion mandate to ensure health IT plays a central role 
in transforming care through the EHR Incentive Program and its 
meaningful use provisions, while the Affordable Care Act ensures that 
performance measures, supported by an electronic infrastructure, drive 
a national strategy for quality improvement. Health IT will help ensure 
care is safer, more affordable, and better coordinated. But to get 
there, a common language among systems is necessary, and EHRs and other 
tools must capture the right data to support performance measurement. 
This will give actionable data to providers, patients, and others 
working to improve quality.

NQF and Health IT: Putting It in Context

    To understand NQF's accomplishments in health IT in 2010-2011, it 
is important to understand two projects that NQF previously completed 
in this area:
    1. The Quality Data Model (QDM, formerly known as the Quality Data 
Set, or QDS): The QDM, developed by NQF's Health Information Technology 
Expert Panel (HITEP), is a set of data elements or types of data 
elements that can be used as the basis for developing harmonized and 
machine-computable performance measures. It is a classification system 
that describes clinical quality information so that it may be shared 
for quality measurement, clinical research, and public health, all of 
which repurpose information recorded during clinical care. As the QDM 
is applied to new measures, measure retooling efforts, and supporting 
EHR use, the model will evolve, requiring oversight and expert advice. 
The QDM provides direction to measure developers, EHR vendors, and 
other stakeholders on how to define quality terminology without 
ambiguity. Although the QDM was developed under an earlier grant from 
the Agency for Healthcare Research and Quality, its implementation is 
covered under the current HHS contract. For more information about the 
QDM, please visit http://www.qualityforum.org/Projects/h/QDS_Model/Quality_Data_Set_Model.aspx.
    2. The ``eMeasure'': The eMeasure is the electronic format for 
representing a performance measure in a machine-readable electronic 
format. Through standardization of a measure's structure, metadata, 
definitions, and logic, the eMeasure provides quality measure 
consistency and unambiguous interpretation. The eMeasure is becoming 
part of NQF's measure submission, endorsement, and maintenance 
requirements. This work was performed in 2009-2010 under the HHS 
contract as Task 9.3.
    NQF's health IT portfolio supports the creation of this electronic 
infrastructure. In 2010-2011 under the HHS contract, NQF undertook 
several projects in health IT, including:
     The development of a measure authoring tool (Task 9.1);
     The convening of a Clinical Decision Support Expert Panel 
(Task 9.2);
     Maintenance of its previously developed Quality Data Model 
(Task 9.5);
     The convening of a Health IT Utilization Expert Panel 
(Task 9.6);
     Measure retooling for EHRs (Task 9.7); and
     The convening of an eMeasure Format Review Panel (Task 
9.8).
Measure Authoring Tool
    Under the HHS contract, NQF is sponsoring the development of a 
software tool that measure developers will use to create the eMeasure. 
The tool will be Web based, easy to use, and maintained over time for 
use in NQF's measure submission process. It will allow a measure 
developer, knowing clinical concepts, to enter information into the 
tool and come out with a standard healthcare quality measure format in 
what is known as Extensible Markup Language, or XML, that any EHR can 
implement. NQF has engaged a subcontractor, the Iowa Foundation for 
Medical Care, to develop this tool. It is anticipated that the measure 
authoring tool will be available for public use by late 2011.
Clinical Decision Support Expert Panel
    Properly positioned within an EHR system, clinical decision support 
(CDS) tools can play an important role in matching patient information 
with relevant clinical knowledge, thereby helping clinicians 
incorporate that knowledge into decision-making. CDS is an essential 
capability of health IT systems; however, a common classification or 
taxonomy is necessary to enable system developers, system implementers, 
and the quality improvement community to develop tools, content, and 
policies that are compatible and support CDS features and functions. In 
2010, under the HHS contract, NQF convened an Expert Panel with 
expertise in CDS and performance measurement. The members of the panel 
assisted in identifying best practices and reducing duplicative or 
uncoordinated efforts. In December, the panel published the report 
Driving Quality and Performance Measurement--A Foundation for Clinical 
Decision Support, featuring a taxonomy for CDS that represents CDS 
rules and elements, while ensuring concordance with the Quality Data 
Model (QDM).
Quality Data Model Maintenance
    The QDM is a model of presenting information that allows measure 
developers to express what they want to say, or what information they 
want to pull from a health record, in a way that EHRs can understand. 
To ensure the value and use of the QDM, NQF will enhance it 
periodically in response to evolving needs for performance measurement. 
While the QDM was created under a separate contract, its maintenance 
and revision is covered

[[Page 55485]]

under the HHS contract. The QDM Version 2.1 is the most current, 
containing updates to QDM data type definitions as well as additional 
elements updates, based on comments received on the QDM Version 2 in 
July 2010. The next version of the QDM will be posted for public 
comment in spring 2011, following a semi-annual update schedule.
Health IT Utilization Expert Panel
    Proper use of health IT (e.g., EHRs, personal health records) and 
its core features and functions is essential to improving quality of 
care. However, health IT also can have unintended consequences and 
introduce safety hazards (e.g., wrong drug chosen due to proximity on 
the screen to another drug, problem list fails to show all problems). 
Thus, in 2010, under the HHS contract, NQF convened an expert panel to 
examine the information needed to measure effective health IT use in 
order to understand better how health IT tools can improve the 
efficiency, quality, and safety of healthcare delivery. The panel 
created a model to measure health IT use, establishing a taxonomy of 
different types of performance measures that might be developed to 
assess whether health IT is being used properly by clinicians and 
others, including assessing whether decision support tools are being 
used effectively and methods of detecting hazards. The project also 
identified methods of testing health IT utilization measures and type 
and level of evidence necessary to support endorsement and will provide 
guidance pertaining to system certification requirements. The panel 
published its report, Driving Quality--A Health IT Assessment, in 
December 2010.
Measure Retooling for EHRs
    At the request of HHS, NQF in 2010 managed the conversion, or 
``retooling,'' of a set of 113 measures from their paper-based format 
to the eMeasure format, working in coordination with their original 18 
developers. These NQF-endorsed quality measures needed to be converted 
so that the data elements are defined using the eMeasure format and in 
the context of EHR usage. The goal is to measure quality directly out 
of EHRs. These measures, a mix of inpatient and ambulatory measures, 
were chosen by HHS for retooling for potential inclusion in the CMS EHR 
Incentive Program. The 113 measures, along with detailed 
eSpecifications, eMeasure code list descriptors, and a guide to how to 
view and interpret an electronic measure, can be found on the NQF Web 
site at http://www.qualityforum.org/Projects/e-g/eMeasures/Electronic_Quality_Measures.aspx.
    The first 44 measures produced were included in the July 2010 
Meaningful Use Stage 1 measures. The project included a complete review 
of efforts required to convert paper-based measures to eMeasure format, 
including use of the QDM and guidance on how to present logic and 
timing for each element in a standard manner. NQF incorporated feedback 
from a large number of public comments in the model used for the final 
product delivered to HHS. The information learned also was incorporated 
into the measure authoring tool software development effort. This 
project was completed under the HHS contract in 2010.
eMeasure Format Review Panel
    Closely related to the measure retooling project, NQF in 2010 under 
the HHS contract convened a body of experts to participate in a panel 
to conduct a transparent and thorough review of the retooled measures. 
This panel will oversee an eMeasure review process to evaluate the 
specifications (structure) and intent (content) of retooled measures. 
This evaluation ensures that a measure's intent remains intact for 
continued NQF endorsement. The review panel's work is ongoing.

Development of a Public Web Site (Task 11)

    The HHS contract provided funding for NQF to revamp and maintain 
its Web site, http://www.qualityforum.org, to allow measure developers, 
members, and the public easier access to relevant documents.
    Under the HHS contract, NQF in 2010 substantially overhauled its 
Web site, developing and maintaining content and supporting materials 
for numerous HHS-supported consensus development projects and other 
tasks, and adding web analytics to make it easier to determine the 
actual needs of public consumers seeking information about NQF 
projects. To facilitate access to endorsed measures, NQF has 
established a measures database that will be considerably enhanced in 
2011 with more advanced search capabilities. NQF also has streamlined 
its web submission forms to reduce time to process items, created a new 
health IT content area to reflect the health IT work conducted under 
this contract, and created commenting tools that allow for open-ended 
or guided public comments. The Web site now features a content 
management system with an online measure submission form, an online 
public and member comment capability, and online voting platform for 
members. Important pages on the Web site include:
     A page containing all MIPPA-funded consensus development 
activity, http://www.qualityforum.org/Projects.aspx;
     A home for all of its health IT activity, http://www.qualityforum.org/Topics/Health_Information_Technology_
(HIT).aspx; and
     An online measure submission form, which can be accessed 
through http://www.qualityforum.org/Measuring_Performance/Submitting_Standards.aspx.
    Further enhancements planned for 2011 include integrating the 
Measure Authoring Tool to allow seamless access to measure developers 
needing to develop eMeasures.

Measure Development, Harmonization, and Endorsement to Fill Gaps (Task 
12)

    The HHS contract provides for measure development and related 
activities to fill immediate areas of need that HHS has identified. In 
2010, HHS requested work in four areas:
     Efficiency and resource use (Task 12.1);
     Measure harmonization (Task 12.2);
     ICD-10 conversion guidance (Task 12.3); and
     Emergency regionalization (Task 12.5).
Efficiency and Resource Use
    Under the HHS contract, NQF in 2010 conducted in two projects 
related to efficiency. The first focuses on endorsing measures of 
imaging efficiency, noting that Medicare spends approximately $14 
billion annually on outpatient imaging studies.\6\ At the close of the 
reporting period, NQF had sent six imaging efficiency measures to the 
Board for ratification. (All were subsequently endorsed shortly after 
the close of the reporting period.) The second project was a white 
paper on resource use measures, which was posted for public comment in 
the fall of 2010. This draft white paper, now being revised to respond 
to HHS and public input, will inform a consensus development project, 
ongoing in 2011, that will endorse a set of resource use measures to 
gauge the cost of healthcare services provided.
Harmonization
    The current quality landscape includes many quality reporting 
initiatives and measure developers, as well as a proliferation of 
measures. Separate quality initiatives--focusing on different settings 
and patient

[[Page 55486]]

populations--often lead to duplicative or overlapping measures. 
Multiple measures with varying specifications that have essentially the 
same focus can create confusion in choosing measures for 
implementation, while differences in measure specifications limit 
comparability and understanding of measure results across settings or 
patient populations. Thus, it is necessary to adopt more global, 
``harmonized'' quality measures in all settings.
    In 2010, under the HHS contract, NQF convened a Steering Committee 
to develop operational guidance for achieving harmonization within 
future NQF consensus development projects. The final project report, 
Guidance for Measure Harmonization, was competed in January 2011.
ICD-10 Conversion
    In 2013, one of the code sets that HHS uses to classify healthcare 
will be upgraded. This transition from the International Classification 
of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes to 
the International Classification of Diseases, Tenth Revision, Clinical 
Modification and Procedure Coding System (ICD-10-CM/PCS) has 
implications for quality measurement because a majority of the 
diagnoses used to define NQF-endorsed measures are specified using ICD-
9-CM codes.
    To prepare for this major transition, NQF examined the implications 
for its measure maintenance procedures and analyzed the impact of code 
transitions for the measurement community, particularly measure 
developers, as the healthcare field begins to shape processes to 
accommodate the necessary measure updates. In October 2010, NQF 
published a report, ICD-10-CM/PCS Coding Maintenance Operational 
Guidance, detailing a series of recommendations to assist measure 
developers and NQF in this transition to ICD-10.
Emergency Regionalization
    Regionalizing emergency medical care services--i.e., directing 
patients to emergency facilities with optimal capabilities for a given 
type of illness or injury in order to coordinate emergency care across 
a region--is one policy option for improving care while making more 
efficient use of medical resources. Under the HHS contract, NQF has 
undertaken a project to identify quality measures already in place and 
identify gaps in the measurement of regionalized emergency medical care 
services that must be filled if one is to provide a detailed picture of 
the utilization and quality of emergency services at the national, 
state, and regional levels. The first phase of this work, conducting an 
environmental scan of existing projects and performance measures and 
developing a framework to guide measure development and identify gaps 
as well as points of leverage for regionalization of emergency medical 
services, was begun in late 2010 and is expected to be completed in 
early 2012.

Recommendations on the National Quality Strategy (Task 13)

    The Affordable Care Act, which became law March 23, 2010, calls for 
HHS to establish a National Health Care Quality Strategy that will 
integrate multiple public- and private-sector quality improvement 
initiatives. This strategy will ultimately include a comprehensive 
strategic plan and the identification of priorities to improve the 
delivery of healthcare services, patient health outcomes, and 
population health. In September 2010, the HHS-NQF contract was modified 
to comply with Section 3014 of the Affordable Care Act, which requires 
the Secretary of HHS to consult with a consensus-based entity to 
convene a multi-stakeholder group to provide input on national 
priorities for improvement in population health and in the delivery of 
health care services for consideration under the National Quality 
Strategy. NQF convened the National Priorities Partnership to 
accomplish this project, which became Task 13 under the HHS contract.
    In October 2010, the NPP submitted its report to HHS, identifying 
eight priority areas for national action. These include the original 
six priorities that the NPP identified in 2008--patient and family 
engagement, population health, safety, care coordination, palliative 
and end-of-life care, and overuse--and the addition of two areas of 
focus: Equitable access to ensure that all patients have access to 
affordable, timely, and high-quality care; and infrastructure supports 
(e.g., health IT) to address underlying system changes that will be 
necessary to attain the goals of the other priority areas. NPP also 
offered aspirational and actionable goals to be achieved over the next 
three to five years for each priority area.

[[Page 55487]]

[GRAPHIC] [TIFF OMITTED] TN07SE11.001

Notes

    1. NQF, Prioritization of High-Impact Medicare Conditions and 
Measure Gaps, Washington, DC: NQF; 2010.
    2. The list of the top 20 high-impact Medicare conditions was 
provided to NQF by HHS, as those conditions that account for 95 
percent of Medicare costs based on an analysis of claims in CMS's 
Chronic Conditions Warehouse. Available at http://ccwdata.org/. Last 
accessed January 2011.
    3. NQF, A National Framework and Preferred Practices for 
Palliative and Hospice Care Quality: A Consensus Report, Washington, 
DC: NQF; 2006.
    4. NQF, National Voluntary Consensus Standards for Nursing Home 
Care: A Consensus Report, Washington, DC: NQF; 2004.
    5. NQF's Measure Evaluation Criteria can be found at http://www.qualityforum.org/docs/measure_evaluation_criteria.aspx. Last 
accessed December 2010.
    6. US Government Accountability Office (GAO), Medicare Part B 
Imaging Services: Rapid Spending Growth and Shift to Physician 
Offices Indicate Need for CMS to Consider Additional Management 
Practices, Washington, DC: GPO; 2008. Available at http://www.gao.gov/new.items/d08452.pdf. Last accessed January 2011.

V. Looking Forward

    It now has been just over two years since NQF began its work with 
HHS under the contract following the Medicare Improvements for Patients 
and Providers Act. This contract has led to specific, measurable 
results.
    Accomplishments have included:
     The presentation of multi-stakeholder input on the 
Secretary's National Quality Strategy, with the foundation being laid 
for a strong public-private partnership focused on achieving the aims 
of that strategy;
     The endorsement of performance measures in key gap areas, 
including measures of care transitions for acute myocardial infarction, 
heart failure, and pneumonia; inpatient psychiatric hospital measures; 
and measures addressing population health and care coordination; and
     The migration of performance measures to an electronic 
platform and the development of a process by which measures can be more 
easily adapted to an electronic format.
    Much work remains to be done on these and other initiatives central 
to improving the quality of American healthcare. But the work performed 
in the past two years comprises an important foundation upon which the 
nation's healthcare quality enterprise can continue to build.
    In 2011, NQF will continue to convene multiple stakeholders to 
provide input to HHS on its priority- and goal-setting efforts, endorse 
and maintain an even greater number of performance measures, and 
facilitate the integration of performance measurement into electronic 
health records. Additionally, NQF is just beginning to implement work 
called for under the Affordable Care Act. This will be centered on the 
establishment of the Measure Applications Partnership, a multi-
stakeholder group that will provide input to the HHS Secretary on the 
selection of quality measures for public reporting and payment 
programs.
    The nation's quality infrastructure, of which NQF is a part, is 
still being built--but its foundations are strong. NQF remains 
committed to working with HHS and its agencies to refashion the 
American healthcare system into one that is, as the IOM envisioned, 
safe, timely, effective, efficient, equitable, and patient centered.

Appendix A: Summary of Accomplishments Under the Contract: Jan. 14, 
2010, to Jan. 13, 2011

----------------------------------------------------------------------------------------------------------------
                                                                     Status (as of 01/13/
        Task               Description               Output                  11)                   Notes
----------------------------------------------------------------------------------------------------------------
6 National Strategy and Priorities
----------------------------------------------------------------------------------------------------------------

[[Page 55488]]

 
6.0.................  Prioritization of      Report with list of    Completed May 2010...  Prioritization of
                       Medicare high-impact   20 high-impact                                High-Impact Medicare
                       conditions.            conditions,                                   Conditions and
                                              prioritized.                                  Measure Gaps http://www.qualityforum.org/projects/prioritization.aspx#t=2&s=&p=4%7C.
6.1.................  Analysis of uses of    Work plan and list of  In progress..........  Project delayed to
                       NQF-endorsed           research questions                            address issues of
                       measures.              completed; report                             intellectual
                                              pending.                                      property and ability
                                                                                            of proposed
                                                                                            subcontractor to
                                                                                            publish under HHS
                                                                                            contract.
6.2.................  Measure development    Report setting agenda  Completed January      Measure Development
                       and endorsement        for measure            2011.                  and Endorsement
                       agenda.                development and                               Agenda http://
                                              endorsement.                                  www.qualityforum.org/
                                                                                            MeasureDevelopmentan
                                                                                            dEndorsementAgenda.a
                                                                                            spx#t=2&s=&p=4%7C.
6.3.................  Analysis of measures   Work plan completed..  In progress..........  Project delayed to
                       being used to gauge                                                  address issues of
                       quality of care for                                                  intellectual
                       people with multiple                                                 property and ability
                       chronic conditions.                                                  of proposed
                                                                                            subcontractor to
                                                                                            publish under HHS
                                                                                            contract.
6.4.................  Analysis of potential  Report proposing a     Completed July 2010..  Identification of
                       ``Meaningful Use''     framework and                                 Potential 2013 e-
                       measures.              criteria for                                  Quality Measures
                                              selection of 2013 MU                          http://
                                              measures; and                                 www.qualityforum.org/
                                              identification of                             projects/i-m/
                                              available measures.                           meaningful_use/
                                                                                            meaningful_use.aspx
                                                                                            .
----------------------------------------------------------------------------------------------------------------
7 Implementation................................................................................................
----------------------------------------------------------------------------------------------------------------
7.1.................  Patient outcomes.....  Three-phase project    In progress..........  Eight measures
                                              endorsing measures                            endorsed during
                                              specific to outcomes                          contract year (an
                                              on Medicare high-                             additional 27
                                              impact conditions,                            measures
                                              child health, and                             subsequently
                                              mental health.                                endorsed in January
                                                                                            2011 after close of
                                                                                            reporting period).
7.2.................  Care coordination....  N/A..................  N/A..................  Project moved at HHS
                                                                                            request to 2011, to
                                                                                            be funded by the
                                                                                            Affordable Care Act.
7.3.................  Patient safety:        Reviewing existing     In progress..........  Updated SRE list
                       Serious Reportable     list of SREs for                              applicable to new
                       Events (SREs).         hospitals to                                  environments of care
                                              identify ones                                 expected Spring
                                              appropriate for                               2011.
                                              other settings;
                                              considering
                                              potential new SREs
                                              for all settings.
7.3.................  Patient safety:        Two-phase project      In progress..........  Measures from Phase 1
                       Measures.              endorsed new                                  expected Spring
                                              measures of patient                           2011; measures from
                                              safety (e.g.,                                 Phase 2 expected
                                              healthcare                                    Summer 2011.
                                              associated
                                              infections,
                                              medication safety)
                                              and maintaining
                                              currently endorsed
                                              measures.
7.3.................  Patient safety:        Report providing       Completed September    National Voluntary
                       Guidance for           public reporting       2010.                  Consensus Standards
                       publicly reporting     guidance.                                     for Public Reporting
                       safety information.                                                  of Patient Safety
                                                                                            Event Information
                                                                                            http://www.qualityforum.org/Projects/Safety_Reporting_Framework/Framework.aspx#t=2&s=&p=5%7C.
7.3.................  Patient safety: State- Convened 27 state-     In progress..........  Final HHS-funded call
                       based reporting        based patient safety                          completed after
                       agencies initiative.   reporting agencies                            reporting period
                                              to discuss safety                             (January 24, 2011)
                                              reporting efforts                             per schedule.
                                              and share ``best
                                              practices''.
7.4.................  Palliative care......  Endorsed measures of   In progress..........  Endorsed measures
                                              palliative care                               expected November
                                              quality.                                      2011.
7.5.................  Nursing homes........  Endorsed measures of   In progress..........  Project completed and
                                              nursing home care                             five measures
                                              quality.                                      endorsed in February
                                                                                            2011 after close of
                                                                                            contract year.
7.6.................  Evaluation of NQF      Report analyzing NQF   Completed January      Assessment of the
                       endorsement process.   Endorsement Process.   2011.                  National Quality
                                                                                            Forum's Consensus
                                                                                            Development Process
                                                                                            (Mathematica Policy
                                                                                            Research, Inc.)
                                                                                            http://www.qualityforum.org/Measuring_Performance/Improving_NQF_Process/Improving_NQF_S_Processes.aspx px.
7.8.................  Child health measures  Endorsed measures      In progress..........  Endorsed measures
                                              specific to the care                          expected Summer
                                              of children.                                  2011.
----------------------------------------------------------------------------------------------------------------
8 Measure Maintenance
----------------------------------------------------------------------------------------------------------------

[[Page 55489]]

 
                      NQF measure            Created systematized   Completed August 2011  .....................
                       endorsement and        process and schedule
                       maintenance: process   for maintaining all
                       and schedule.          NQF-endorsed
                                              measures over three-
                                              year period.
                      Cardiovascular         Two-phase project to   In progress..........  Endorsed measures
                       measure maintenance.   endorse new                                   from Phase 1
                                              cardiovascular                                anticipated November
                                              measures and conduct                          2011, from Phase 2
                                              maintenance on                                anticipated January
                                              existing ones.                                2012.
                      Surgery measures       Two-phase project to   In progress..........  Endorsed measures
                       maintenance.           maintain NQF-                                 from Phase 1
                                              endorsed surgery                              anticipated November
                                              measures and                                  2011; from Phase 2
                                              consider new ones.                            anticipated January
                                                                                            2012.
----------------------------------------------------------------------------------------------------------------
9 Health Information Technology
----------------------------------------------------------------------------------------------------------------
9.1.................  Measure authoring      Work with              In progress..........  Beta version
                       tool.                  subcontractor to                              developed by 01/13/
                                              create tool that                              11; beta testing to
                                              would allow a                                 take place late
                                              measure developer to                          2011.
                                              standardize data
                                              elements for writing
                                              measures
                                              electronically.
9.2.................  Clinical Decision      Produced report on     Completed December     Driving Quality and
                       Support Project.       performance            2010.                  Performance
                                              measurement and                               Measurement--A
                                              clinical decision                             Foundation for
                                              support.                                      Clinical Decision
                                                                                            Support released in
                                                                                            December 2010 http://
                                                                                            www.qualityforum.org/
                                                                                            Publications/2010/12/
                                                                                            Driving_Quality_an
                                                                                            d_Performance_Meas
                                                                                            urement__-A_
                                                                                            Foundation_for_Cli
                                                                                            nical_Decision_Sup
                                                                                            port.aspx.
9.5.................  Quality Data Model     Updated QDM to         Ongoing Fall 2010....  Released version 2.1
                       (QDM) Maintenance.     reflect additional                            of QDM in Fall 2010
                                              types of data needed                          for public comment
                                              to support emerging                           http://
                                              measures (e.g.,                               www.qualityforum.org/
                                              measures that                                 Projects/h/QDS_
                                              include social                                Model/Quality_Data_
                                              determinants of                               Model.aspx#t=2&s=&p=
                                              health).                                      3%7C.
9.6.................  Health IT Utilization  Produced report on     Completed December     Driving Quality--A
                       Project.               potential types of     2010.                  Health IT Assessment
                                              measures of health                            Framework released
                                              IT use and early                              in December 2010
                                              detection of                                  http://
                                              unintended                                    www.qualityforum.org/
                                              consequences.                                  Publications/2010/
                                                                                            12/Driving--Quality--
                                                                                            ---A--Health--IT--As
                                                                                            sessment--Framework-
                                                                                            -for--Measurement.as
                                                                                            px.
9.7.................  Measure retooling for  Retooled 113 NQF-      Completed December     Measures and
                       EHRs.                  endorsed measures      2010.                  eSpecifications have
                                              for use in EHRs.                              been posted on NQF
                                                                                            website for public
                                                                                            comment and can be
                                                                                            found at http://www.qualityforum.org/Projects/e-g/eMeasure_Format_Review/eMeasure_Format_Review.aspx#t=2&s=&p=4%7C.
9.8.................  eMeasure Format        Convened panel to      Ongoing..............  Completed first cycle
                       Review Panel.          review retooled                               of review in Fall
                                              measures from Task                            2010, following
                                              9.7 to ensure the                             public comment
                                              eSpecifications of                            period.
                                              these measures is
                                              consistent with the
                                              original focus and
                                              intent of the
                                              measure.
----------------------------------------------------------------------------------------------------------------
11 Website
----------------------------------------------------------------------------------------------------------------
                      Public-facing Web      Update and enhance     Ongoing..............  Added online measure
                       site.                  NQF Web site to                               submission form
                                              support and enable                            included adapted
                                              projects funded                               versions for
                                              under this contract.                          efficiency measures,
                                                                                            new public
                                                                                            commenting tool, and
                                                                                            improved online
                                                                                            voting platform.
----------------------------------------------------------------------------------------------------------------
12 Measurement Development, Harmonization, and Endorsement
----------------------------------------------------------------------------------------------------------------

[[Page 55490]]

 
12.1................  Efficiency and         Endorsed measures of   In progress..........  Six imaging
                       resource use.          imaging efficiency;                           efficiency measures
                                              white paper drafted;                          endorsed February
                                              endorsed measures of                          2011; one imaging
                                              healthcare                                    efficiency measure
                                              efficiency.                                   was recommended to
                                                                                            be combined with an
                                                                                            existing NQF
                                                                                            measure. White paper
                                                                                            being redrafted to
                                                                                            respond to comments.
                                                                                            Healthcare
                                                                                            efficiency resource
                                                                                            use measures
                                                                                            endorsement project
                                                                                            delayed to allow
                                                                                            time for developers
                                                                                            to complete measures
                                                                                            and to better
                                                                                            coordinate with
                                                                                            related work in HHS,
                                                                                            but now underway.
12.2................  Harmonization........  Report with guidance   Completed December     Guidance for Measure
                                              for measure            2010.                  Harmonization in
                                              developers on how to                          press.
                                              approach
                                              harmonization of
                                              quality measures
                                              across settings and
                                              patient populations.
12.3................  ICD-10 conversion      Report on how to       Completed September    ICD-10-CM/PCS Coding
                       guidance.              convert from ICD-9     2011.                  Maintenance
                                              to ICD-10.                                    Operational
                                                                                            Guidance: A
                                                                                            Consensus Report
                                                                                            http://
                                                                                            www.qualityforum.org/
                                                                                            Publications/2010/10/
                                                                                            ICD-10-CM/PCS_
                                                                                            Coding_
                                                                                            Maintenance_Operati
                                                                                            onal_Guidance.aspx.
12.5................  Emergency              Environmental scan     In progress..........  Final report expected
                       regionalization.       and white paper                               November 2011.
                                              comparing how
                                              regions coordinate
                                              and perform on
                                              delivering emergency
                                              services.
----------------------------------------------------------------------------------------------------------------
13 National Quality Strategy: Priorities
----------------------------------------------------------------------------------------------------------------
                      Input on priorities    Report to the          Completed October      Input to the
                       for the National       Secretary of HHS       2010.                  Secretary of Health
                       Strategy for Quality   with recommendations                          and Human Services
                       Improvement.           on priorities and                             on Priorities for
                                              goals for the                                 the 2011 National
                                              proposed National                             Quality Strategy
                                              Quality Strategy.                             http://www.nationalprioritiespartnership.org/.
----------------------------------------------------------------------------------------------------------------

Appendix B: List of Measures Endorsed

    Includes 62 newly endorsed resulting from the work conducted during 
the contract period, 14 endorsed prior to the close of the contract 
period, and another 48 awaiting final ratification by the NQF Board of 
Directors (which occurred shortly after the close of the contract 
period).

----------------------------------------------------------------------------------------------------------------
                                                                       Subject/topic area
                                                                        (e.g., condition,    Status as of 01/13/
       Measure No.            Measure name         Care setting(s)       setting, cross-            2011
                                                                          cutting area)
----------------------------------------------------------------------------------------------------------------
OT2-002-09..............  Risk adjusted         Hospital............  Surgery.............  Awaiting Board
                           colorectal surgery                                                ratification
                           outcome measure.                                                  (endorsed 1/17/11).
OT1-008-09..............  Hospital 30-day risk- Hospital............  Cardiovascular......  Endorsed.
                           standardized
                           readmission rates
                           following
                           percutaneous
                           coronary
                           intervention (PCI).
OT1-015-09..............  Risk adjusted case    Hospital............  Cross-cutting/        Awaiting Board
                           mix adjusted                                Surgery.              ratification
                           elderly surgery                                                   (endorsed 1/17/11).
                           outcomes measure.
OT1-007-09..............  Hospital risk-        Hospital............  Cardiovascular......  Endorsed.
                           standardized
                           complication rate
                           following
                           implantation of
                           implantable
                           cardioverter-
                           defibrillator (ICD).
OT1-020-09..............  Functional capacity   Other...............  Respiratory/ICU.....  Endorsed.
                           in COPD patients
                           before and after
                           pulmonary
                           rehabilitation.
OT1-019-09..............  Health-related        Other...............  Respiratory/ICU.....  Endorsed.
                           quality of life in
                           COPD patients
                           before and after
                           pulmonary
                           rehabilitation.
OT1-024-09..............  Intensive care: in-   Hospital............  Respiratory/ICU.....  Endorsed.
                           hospital mortality
                           rate.

[[Page 55491]]

 
OT1-023-09..............  Intensive Care Unit   Hospital............  Respiratory/ICU.....  Endorsed.
                           (ICU) length-of-
                           stay (LOS).
OT1-031-09..............  Proportion of         Hospital............  Neurology (Stroke)..  Awaiting Board
                           patients                                                          ratification
                           hospitalized with                                                 (endorsed 1/17/11).
                           stroke that have a
                           potentially
                           avoidable
                           complication
                           (during the index
                           stay or in the 30-
                           day post-discharge
                           period).
OT1-030-09..............  Proportion of         Hospital............  Cardiovascular......  Awaiting Board
                           patients                                                          ratification
                           hospitalized with                                                 (endorsed 1/17/11).
                           AMI that have a
                           potentially
                           avoidable
                           complication
                           (during the index
                           stay or in the 30-
                           day post-discharge
                           period).
OT2-013-09..............  Proportion of         Hospital............  Respiratory/ICU.....  Awaiting Board
                           patients                                                          ratification
                           hospitalized with                                                 (endorsed 1/17/11).
                           pneumonia that have
                           a potentially
                           avoidable
                           complication
                           (during the index
                           stay or in the 30-
                           day post-discharge
                           period).
OT1-013-09..............  The STS CABG          Hospital............  Surgery.............  Awaiting Board
                           composite score.                                                  ratification
                                                                                             (endorsed 1/17/11).
OT1-016-09..............  30-Day post-hospital  Hospital............  Cardiovascular......  Endorsed.
                           AMI discharge care
                           transition
                           composite measure.
OT1-017-09..............  30-Day post-hospital  Hospital............  Cardiovascular......  Endorsed.
                           HF discharge care
                           transition
                           composite measure.
OT2-005-09..............  30-Day post-hospital  Hospital............  Respiratory/ICU.....  Awaiting Board
                           pneumonia discharge                                               ratification
                           care transition                                                   (endorsed 1/17/11).
                           composite measure.
OT2-022-09..............  Proportion of         Health Plan; Group;   Cross-cutting.......  Awaiting Board
                           patients with         Population.                                 ratification
                           chronic conditions                                                (endorsed 1/17/11).
                           that have a
                           potentially
                           avoidable
                           complication during
                           the calendar year.
OT3-057-10..............  Asthma admission      Other...............  Outcomes/child        Awaiting Board
                           rate.                                       health: asthma.       ratification
                                                                                             (endorsed 1/17/11).
OT3-055-10..............  Gastroenteritis       Hospital............  Outcomes/child        Awaiting Board
                           admission rate                              health.               ratification
                           (pediatric).                                                      (endorsed 1/17/11).
OT3-046-10..............  Validated family-     Hospital............  Outcomes/child        Awaiting Board
                           centered survey                             health: survey,       ratification
                           questionnaire for                           patient experience    (endorsed 1/17/11).
                           parents' and                                of care.
                           patients'
                           experiences during
                           inpatient pediatric
                           hospital stay.
OT3-045-10..............  Measure of medical    Other...............  Outcomes/child        Awaiting Board
                           home for children                           health: access to     ratification
                           and adolescents.                            care.                 (endorsed 1/17/11).
OT3-044-10..............  Children who have     Other...............  Outcomes/child        Awaiting Board
                           inadequate                                  health: access to     ratification
                           insurance coverage                          care.                 (endorsed 1/17/11).
                           for optimal health.
OT3-043-10..............  Pediatric symptom     All settings........  Outcomes/child        Awaiting Board
                           checklist (PSC).                            health: survey.       ratification
                                                                                             (endorsed 1/17/11).
OT3-041-10..............  Children who attend   Other...............  Outcomes/child        Awaiting Board
                           schools perceived                           health: survey.       ratification
                           as safe.                                                          (endorsed 1/17/11).
OT3-039-10..............  Children who live in  Other...............  Outcomes/child        Awaiting Board
                           communities                                 health: survey.       ratification
                           perceived as safe.                                                (endorsed 1/17/11).
OT3-038-10..............  Children who receive  Other...............  Outcomes/child        Awaiting Board
                           effective care                              health: access to     ratification
                           coordination of                             care.                 (endorsed 1/17/11).
                           healthcare services
                           when needed.
OT3-036-10..............  Children who had      Other...............  Outcomes/child        Awaiting Board
                           problems obtaining                          health: access to     ratification
                           referrals when                              care.                 (endorsed 1/17/11).
                           needed.
OT3-032-10..............  Number of school      Other...............  Outcomes/child        Awaiting Board
                           days children miss                          health: survey.       ratification
                           due to illness.                                                   (endorsed 1/17/11).
OT3-031-10..............  Healthy term newborn  Hospital............  Outcomes/child        Awaiting Board
                                                                       health: perinatal.    ratification
                                                                                             (endorsed 1/17/11).

[[Page 55492]]

 
OT3-029-10..............  Standardized adverse  Hospital............  Outcomes/child        Awaiting Board
                           event ratio for                             health: cardiology.   ratification
                           children and adults                                               (endorsed 1/17/11).
                           undergoing cardiac
                           catheterization for
                           congenital heart
                           disease.
OT3-028-10..............  Standardized          Hospital............  Outcomes/child        Awaiting Board
                           mortality ratio for                         health: mortality.    ratification
                           neonates undergoing                                               (endorsed 1/17/11).
                           non-cardiac surgery.
OT3-027-10..............  Ventriculoperitoneal  Hospital............  Outcomes/child        Awaiting Board
                           (VP) shunt                                  health.               ratification
                           malfunction rate in                                               (endorsed 1/17/11).
                           children.
OT3-011-10..............  Depression remission  Ambulatory care:      Mental health/        Awaiting Board
                           at twelve months.     office, clinic,       depression.           ratification
                                                 behavioral health/                          (endorsed 1/17/11).
                                                 psychiatric unit.
OT3-012-10..............  Depression remission  Ambulatory care:      Mental health/        Awaiting Board
                           at six months.        office, clinic,       depression.           ratification
                                                 behavioral health/                          (endorsed 1/17/11).
                                                 psychiatric unit.
OT3-022-10..............  Depression            Ambulatory care:      Mental health/        Awaiting Board
                           utilization of the    office, clinic,       depression.           ratification
                           PHQ-9 tool.           behavioral health/                          (endorsed 1/17/11).
                                                 psychiatric unit.
OT3-047-10..............  Inpatient consumer    Hospital, long-term   Mental health/        Awaiting Board
                           survey.               acute care            patient experience.   ratification
                                                 hospital,                                   (endorsed 1/17/11).
                                                 behavioral health/
                                                 psychiatric unit.
NH-003-10...............  Physical therapy or   Nursing home/skilled  Nursing homes/falls.  Awaiting Board
                           nursing               nursing facility.                           ratification
                           rehabilitation/                                                   (endorsed 2/28/11).
                           restorative care
                           for long-stay
                           patients with new
                           balance problem.
NH-008-10...............  Percent of residents  Nursing home/skilled  Nursing homes/falls.  Awaiting Board
                           experiencing one or   nursing facility.                           ratification
                           more falls with                                                   (endorsed 2/28/11).
                           major injury (long
                           stay).
NH-009-10...............  The percentage of     Nursing home/skilled  Nursing homes/pain..  Awaiting Board
                           residents on a        nursing facility.                           ratification
                           scheduled pain                                                    (endorsed 2/28/11).
                           medication regimen
                           on admission who
                           report a decrease
                           in pain intensity
                           or frequency (short
                           stay).
NH-010-10...............  Percent of residents  Nursing home/skilled  Nursing homes/pain..  Awaiting Board
                           who self-report       nursing facility.                           ratification
                           moderate to severe                                                (endorsed 2/28/11).
                           pain (short stay).
NH-011-10...............  Percent of residents  Nursing home/skilled  Nursing homes/pain..  Awaiting Board
                           who self-report       nursing facility.                           ratification
                           moderate to severe                                                (endorsed 2/28/11).
                           pain (long stay).
NH-012-10...............  Percent of residents  Nursing home/skilled  Nursing homes/        Awaiting Board
                           with pressure         nursing facility.     pressure ulcers.      ratification (time-
                           ulcers that are new                                               limited).
                           or worsened (short
                           stay).
NH-013-10...............  Percent of high-risk  Nursing home/skilled  Nursing homes/        Awaiting Board
                           residents with        nursing facility.     pressure ulcers.      ratification
                           pressure ulcers                                                   (endorsed 2/28/11).
                           (long stay).
NH-014-10...............  Percent of residents  Nursing home/skilled  Nursing homes/        Awaiting Board
                           who were assessed     nursing facility.     immunization.         ratification
                           and appropriately                                                 (endorsed 2/28/11).
                           given the seasonal
                           influenza vaccine
                           during the flu
                           season (short stay).
NH-015-10...............  Percent of residents  Nursing home/skilled  Nursing homes/        Awaiting Board
                           who were assessed     nursing facility.     immunization.         ratification
                           and appropriately                                                 (endorsed 2/28/11).
                           given the seasonal
                           influenza vaccine
                           (long stay).
NH-016-10...............  Percent of residents  Nursing home/skilled  Nursing homes/        Awaiting Board
                           who were assessed     nursing facility.     immunization.         ratification
                           and appropriately                                                 (endorsed 2/28/11).
                           given the
                           pneumococcal
                           vaccine (short
                           stay).
NH-017-10...............  Percent of residents  Nursing home/skilled  Nursing homes/        Awaiting Board
                           who were assessed     nursing facility.     immunization.         ratification
                           and appropriately                                                 (endorsed 2/28/11).
                           given the
                           pneumococcal
                           vaccine (long stay).
NH-018-10...............  Percent of residents  Nursing home/skilled  Nursing homes/        Awaiting Board
                           with a urinary        nursing facility.     functionality.        ratification
                           tract infection                                                   (endorsed 2/28/11).
                           (long stay).

[[Page 55493]]

 
NH-019-10...............  Percent of low-risk   Nursing home/skilled  Nursing homes/        Awaiting Board
                           residents who lose    nursing facility.     functional status.    ratification
                           control of their                                                  (endorsed 2/28/11).
                           bowels or bladder
                           (long stay).
NH-020-10...............  Percent of residents  Nursing home/skilled  Nursing homes/safety  Awaiting Board
                           who have/had a        nursing facility.                           ratification
                           catheter inserted                                                 (endorsed 2/28/11).
                           and left in their
                           bladder (long stay).
NH-021-10...............  Percent of residents  Nursing home/skilled  Nursing homes/safety  Awaiting Board
                           who were physically   nursing facility.                           ratification
                           restrained (long                                                  (endorsed 2/28/11).
                           stay).
NH-022-10...............  Percent of residents  Nursing home/skilled  Nursing homes/        Awaiting Board
                           whose need for help   nursing facility.     functionality.        ratification
                           with daily                                                        (endorsed 2/28/11).
                           activities has
                           increased (long
                           stay).
NH-024-10...............  Percent of residents  Nursing home/skilled  Nursing homes/        Awaiting Board
                           who lose too much     nursing facility.     functionality.        ratification
                           weight (long stay).                                               (endorsed 2/28/11).
NH-025-10...............  Percent of residents  Nursing home/skilled  Nursing homes/mental  Awaiting Board
                           who have depressive   nursing facility.     health.               ratification
                           symptoms (long                                                    (endorsed 2/28/11).
                           stay).
NH-026-10...............  Consumer Assessment   Nursing home/skilled  Nursing homes/        Awaiting Board
                           of Health Providers   nursing facility.     patient experience.   ratification
                           and Systems                                                       (endorsed 2/28/11).
                           (CAHPS[supreg])
                           Nursing Home
                           Survey: Discharged
                           Resident Instrument.
NH-027-10...............  Consumer Assessment   Nursing home/skilled  Nursing homes/        Awaiting Board
                           of Health Providers   nursing facility.     patient experience.   ratification
                           and Systems                                                       (endorsed 2/28/11).
                           (CAHPS[supreg])
                           Nursing Home
                           Survey: Long-Stay
                           Resident Instrument.
NH-028-10...............  Consumer Assessment   Nursing home/skilled  Nursing homes/        Awaiting Board
                           of Health Providers   nursing facility.     patient experience.   ratification
                           and Systems                                                       (endorsed 2/28/11).
                           (CAHPS[supreg])
                           Nursing Home
                           Survey: Family
                           Member Instrument.
IEP-005-10..............  Pulmonary CT imaging  Ambulatory care: ED   Overuse/safety......  Endorsed.
                           for patients at low   could consider for
                           risk for pulmonary    additional
                           embolism.             ambulatory
                                                 settings: office,
                                                 clinic and hospital
                                                 outpatient.
IEP-007-10..............  Appropriate head CT   Ambulatory care: ED   Overuse/safety......  Endorsed.
                           imaging in adults     could consider for
                           with mild traumatic   additional
                           brain injury.         ambulatory
                                                 settings: office,
                                                 clinic and hospital
                                                 outpatient.
IEP-010-10..............  Cardiac imaging for   Ambulatory care:      Overuse/safety......  Endorsed.
                           preoperative risk     hospital outpatient.
                           assessment for non-
                           cardiac low-risk
                           surgery.
IEP-014-10..............  Cardiac stress        Ambulatory care:      Overuse/safety......  Endorsed.
                           imaging not meeting   hospital
                           appropriate use       outpatient, office.
                           criteria:
                           preoperative
                           evaluation in low
                           risk surgery
                           patients.
IEP-015-10..............  Cardiac stress        Ambulatory care:      Overuse/safety......  Endorsed.
                           imaging not meeting   hospital
                           appropriate use       outpatient, office.
                           criteria: routine
                           testing after
                           percutaneous
                           coronary
                           interventions (PCI).
IEP-016-10..............  Cardiac stress        Ambulatory care:      Overuse/safety......  Endorsed.
                           imaging not meeting   hospital
                           appropriate use       outpatient, office.
                           criteria: testing
                           in asymptomatic,
                           low-risk patients.
----------------------------------------------------------------------------------------------------------------


[[Page 55494]]

Appendix C: Reports Published by NQF Under the HHS Contract Between 
January 14, 2010, and January 13, 2011

    Prioritization of High-Impact Medicare Conditions and Measure Gaps; 
Task 6.0; May 2010 http://www.qualityforum.org/projects/prioritization.aspx#t=2&s=p-4%7C.
    Measure Development and Endorsement Agenda; Task 6.2; January 2011 
http://www.qualityforum.org/MeasureDevelopmentandEndorsementAgenda.aspx.
    Identification of Potential 2013 e-Quality Measures; Task 6.4; 
August 2010 http://www.qualityforum.org/projects/i-m/meaningful_use/meaningful_use.aspx.
    National Voluntary Consensus Standards for Public Reporting of 
Patient Safety Event Information; Task 7.3; September 2010 http://www.qualityforum.org/Projects/Safety_Reporting_Framework/Framework.aspx#t=2&s=&p=5%7C.
    Assessment of the National Quality Forum's Consensus Development 
Process (Mathematica Policy Research, Inc.); Task 7.6; December 2010 
http://www.qualityforum.org/Measuring_Performance/Improving_NQF_Process/Improving_NQF_S_Processes.aspx.
    Driving Quality and Performance Measurement: A Foundation For 
Clinical Decision Support; Task 9.2; December 2010 http://
www.qualityforum.org/Publications/2010/12/Driving_Quality_and_
Performance_Measurement__-A_Foundation_for_Clinical_Decision_
Support.aspx.
    Driving Quality--A Health IT Assessment Framework for Measurement: 
A Consensus Report; Task 9.6; December 2010 http://
www.qualityforum.org/Publications/2010/12/Driving_Quality__-A_
Health_IT_Assessment_Framework_for_Measurement.aspx.
    Guidance for Measure Harmonization; Task 12.2; in press.
    ICD-10-CM/PCS Coding Maintenance Operational Guide: A Consensus 
Report; Task 12.3; October 2010 http://www.qualityforum.org/
Publications/2010/10/ICD-10-CM/PCS_Coding_Maintenance_Operational_
Guidance.aspx.
    Input to the Secretary of Health and Human Services on Priorities 
for the 2011 National Quality Strategy; Task 13; October 2010 http://www.nationalprioritiespartnership.org.

Appendix D: NQF Board of Directors

    William L. Roper, MD, MPH (Chair), Dean, School of Medicine, Vice 
Chancellor for Medical Affairs and Chief Executive Officer, UNC Health 
Care System, University of North Carolina at Chapel Hill.
    Andrew Webber (Vice Chair), President and CEO, National Business 
Coalition on Health.
    Gerald M. Shea (Treasurer), Assistant to the President for External 
Affairs, AFL-CIO.
    Richard J. Baron, MD, FACP, President and Founder, Greenhouse 
Internists.
    Lawrence M. Becker, Director, HR Strategic Partnerships, Xerox 
Corporation.
    JudyAnn Bigby, MD, Secretary, Executive Office of Health & Human 
Services, Commonwealth of Massachusetts.
    Janet M. Corrigan, PhD, MBA, President and CEO, National Quality 
Forum.
    Maureen Corry, Executive Director, Childbirth Connection.
    Helen Darling, MA, President, National Business Group on Health.
    Robert Galvin, MD, MBA, Chief Executive Officer, Equity Healthcare, 
The Blackstone Group.
    Wade Henderson, Esq., President and CEO, Leadership Conference on 
Civil Rights.
    Ardis Dee Hoven, MD, Chair, American Medical Association Board of 
Trustees and Medical Director, Bluegrass Care Clinic, Affiliated with 
the University of Kentucky School of Medicine.
    Karen Ignagni, MBA, President and CEO, America's Health Insurance 
Plans (AHIP).
    Chris Jennings, President, Jennings Policy Strategies, Inc.
    Charles N. Kahn III, MPH, President, Federation of American 
Hospitals.
    Mark B. McClellan, MD, PhD, Senior Fellow and Director, Engelberg 
Center for Health Care Reform and Leonard D. Schaeffer Chair in Health 
Policy Studies, The Brookings Institution.
    Sheri S. McCoy, Worldwide Chairman of the Pharmaceuticals Group, 
Johnson & Johnson.
    Harold D. Miller, President and CEO, Network for Regional 
Healthcare Improvement.
    Dolores L. Mitchell, Executive Director, Commonwealth of 
Massachusetts Group Insurance Commission.
    Mary Naylor, PhD, RN, FAAN, Director, New Courtland Center for 
Transitions & Health and Marian S. Ware Professor in Gerontology, 
University of Pennsylvania School of Nursing.
    Debra L. Ness, President, National Partnership for Women & 
Families.
    Samuel R. Nussbaum, MD, Executive Vice President and Chief Medical 
Officer, WellPoint, Inc.
    J. Marc Overhage, MD, PhD, Director, Regenstrief Institute and 
President and CEO, Health Information Exchange.
    John C. Rother, JD, Executive Vice President for Policy and 
Strategy, AARP.
    Bernard M. Rosof, MD, Chair, Board of Directors, Huntington 
Hospital and Chair, Physician Consortium for Performance Improvement 
convened by the American Medical Association.
    Joseph R. Swedish, FACHE, President and CEO, Trinity Health.
    John Tooker, MD, MBA, FACP, Associate Executive Vice President, 
American College of Physicians.
    Richard J. Umbdenstock, President and CEO, American Hospital 
Association.

CMS

    Donald M. Berwick, Administrator.
    Designee: Barry Straube, MD, Chief Medical Officer and Director, 
Office of Clinical Standards and Quality.

AHRQ

    Carolyn M. Clancy, MD, Director.

NIH

    Francis S. Collins, MD, PhD, Director, National Institutes of 
Health.
    Designee: Barry Portnoy, PhD, Senior Advisor for Disease 
Prevention.

HRSA

    Mary Wakefield, PhD, RN, Administrator.
    Designee: Kyu Rhee, MD.

CDC

    Thomas R. Frieden, MD, MPH, Director.
    Designee: Peter A. Briss, MD, MPH, Captain, U.S. Public Health 
Service, Medical Director.

Ex Officio (Non-Voting)

    Arthur Levin, MPH, (Chair, Consensus Standards Approval Committee), 
Director, Center for Medical Consumers.
    Curt Selquist, (Chair, Leadership Network), Johnson & Johnson 
Health Care System, Inc. (retired).
    Paul C. Tang, MD, MS, Vice President and Chief Medical Information 
Officer, Palo Alto Medical Foundation and Chair, Health Information 
Technology Advisory Committee.

Appendix E: NQF Senior Leadership

    Janet M. Corrigan, President and Chief Executive Officer.
    Karen Adams, Vice President, National Priorities.
    Helen Burstin, Senior Vice President, Performance Measures.
    Floyd Eisenberg, Senior Vice President, Health Information 
Technology.

[[Page 55495]]

    Marybeth Farquhar, Vice President for Performance Measures.
    Larry Gorban, Vice President, Operations.
    Ann Hammersmith, General Counsel.
    Lisa Hines, Vice President, Member Services and Education.
    Laura Miller, Senior Vice President and Chief Operating Officer.
    Nicole Silverman, Vice President, Federal Program Management.
    Mary Shaffran, Vice President, Health Information Technology.
    Diane Stollenwerk, Vice President, Community Alliances.
    Thomas Valuck, Senior Vice President, Strategic Partnerships.
    Kyle Vickers, Chief Information Officer.

Appendix F: National Priorities Partnership

National Committee for Quality Assurance
(Margaret E. O'Kane, MHS, President; NPP Co-Chair)
Physician Consortium for Performance Improvement Convened by the 
American Medical Association
(Bernard Rosof, MD, Chair; NPP Co-Chair)

AARP
AFL-CIO
Aligning Forces for Quality
Alliance for Home Health Quality and Innovation
Alliance for Pediatric Quality
America's Health Insurance Plans
American Board of Medical Specialties
American Health Care Association
American Medical Informatics Association
American Medical Association
American Nurses Association
AQA
Association of State and Territorial Health Officials
Certification Commission for Health Information Technology
Consumers Union
Hospital Quality Alliance
Institute for Healthcare Improvement
Institute of Medicine
Johnson & Johnson Health Care Systems
The Joint Commission
Leapfrog Group
National Association of Community Health Centers
National Association of Medicaid Directors
National Business Group on Health
National Governors Association
National Hispanic Medical Association
National Initiative for Children's Healthcare Quality
National Partnership for Women & Families
National Quality Forum
Network for Regional Healthcare
Nursing Alliance for Quality Care
Pacific Business Group on Health
Partnership for Prevention
Patient Centered Primary Care Collaborative
Pharmacy Quality Alliance
Planetree
Quality Alliance Steering Committee
U.S. Chamber of Commerce

Ex-Officio Partner Organizations

Agency for Healthcare Research and Quality
Centers for Disease Control and Prevention
Centers for Medicare & Medicaid Services
Health Resources and Services Administration
National Institutes of Health
Veterans Health Administration

Appendix G: NQF Consensus Development Process (Version 1.8)

    NQF uses its formal Consensus Development Process (CDP) to evaluate 
and endorse consensus standards, including performance measures, best 
practices, frameworks, and reporting guidelines. The CDP is designed to 
call for input and carefully consider the interests of stakeholder 
groups from across the healthcare industry.
    Because NQF uses this formal CDP, it is recognized as a voluntary 
consensus standards-setting organization as defined by the National 
Technology Transfer and Advancement Act of 1995 \1\ and Office of 
Management and Budget Circular A-119.\2\ Over the past 10 years, the 
procedures that form NQF's CDP and its implementation have evolved to 
ensure that evaluation of candidate consensus standards continues to 
follow best practices in performance measurement and standards-setting. 
NQF is currently using version 1.8 of the CDP.
    NQF's CDP involves nine principal steps. Each contains several 
substeps and is associated with specific actions. The steps are:

1. Call for Intent to Submit Candidate Standards
2. Call for Nominations
3. Call for Candidate Standards
4. Candidate Consensus Standard Review
5. Public and Member Comment
6. Member Voting
7. Consensus Standards Approval Committee (CSAC) Decision
8. Board Ratification
9. Appeals

Notes

    1. U.S. Congress, National Technology Transfer and Advancement 
Act of 1995 (PL 104-113), Washington, DC: U.S. Government Printing 
Office; 1995. Available at http://standards.gov/standards_gov/nttaa.cfm. Last accessed December 2010.
    2. The White House, U.S. Office of Management and Budget, 
Circular No. A-119, February 10, 1998, Washington, DC: Office of 
Management and Budget; 1998. Available at http://www.whitehouse.gov/omb/circulars_a119/. Last accessed December 2010.

Appendix H: List of NQF Member Organizations by Council

Consumer Council

AARP
AFL-CIO
American Federation of Teachers Healthcare
American Hospice Foundation
American Sleep Apnea Association
Childbirth Connection
Citizens for Patient Safety
Coalition for Improving Maternity Services
Community Catalyst
Community Health Foundation of Western and Central New York
Connecticut Center for Patient Safety
Consumer Coalition for Quality Health Care
Consumers Advancing Patient Safety
Consumers' Checkbook
Consumers Union
DES Action USA
Foundation for Informed Medical Decision Making
Health Watch USA
Lamaze International
Mothers Against Medical Error
National Breast Cancer Coalition
National Coalition for Cancer Survivorship
National Consumers League
National Council on Aging
National Health Law Program
National Partnership for Women & Families
National Sleep Foundation
Patient Centered Primary Care Collaborative
PULSE of New York
The Coordinating Center
The Empowered Patient Coalition
The National Consumer Voice for Quality Long-Term Care
The Partnership for Healthcare Excellence
Trauma Support Network
Trust for America's Health

Health Plan Council

Aetna
Alliance of Community Health Plans
America's Health Insurance Plans
Arkansas Medicaid
BlueCross BlueShield Association
CareFirst BlueCross BlueShield
CIGNA HealthCare
Highmark, Inc.
Horizon Blue Cross Blue Shield of New Jersey
Hudson Health Plan
Humana Inc.
Kaiser Permanente
UnitedHealth Group
Universal American Corp
WellPoint

Health Professionals Council

AANAC
Academy of Managed Care Pharmacy
Academy of Medical-Surgical Nurses

[[Page 55496]]

American Academy of Audiology
American Academy of Dermatology
American Academy of Family Physicians
American Academy of Hospice and Palliative Medicine
American Academy of Neurology
American Academy of Nurse Practitioners
American Academy of Ophthalmology
American Academy of Orthopaedic Surgeons
American Academy of Otolaryngology-Head and Neck Surgery
American Academy of Pediatrics
American Academy of Physical Medicine and Rehabilitation
American Association of Birth Centers
American Association of Cardiovascular and Pulmonary Rehabilitation
American Association of Clinical Endocrinologists
American Association of Diabetes Educators
American Association of Neurological Surgeons
American Association of Nurse Anesthetists
American Case Management Association
American Chiropractic Association
American College of Cardiology
American College of Emergency Physicians
American College of Gastroenterology
American College of Nurse-Midwives
American College of Obstetricians and Gynecologists
American College of Physician Executives
American College of Physicians
American College of Radiology
American College of Rheumatology
American College of Surgeons
American Dietetic Association
American Gastroenterological Association Institute
American Geriatrics Society
American Health Information Management Association
American Heart Association
American Medical Association
American Medical Directors Association
American Nurses Association
American Optometric Association
American Organization of Nurse Executives
American Osteopathic Association
American Pharmacists Association Foundation
American Physical Therapy Association
American Psychiatric Nurses Association
American Society for Gastrointestinal Endoscopy
American Society for Radiation Oncology
American Society of Anesthesiologists
American Society of Breast Surgeons
American Society of Clinical Oncology
American Society of Colon and Rectal Surgeons
American Society of Health-System Pharmacists
American Society of Hematology
American Society of Pediatric Nephrology
American Society of Plastic Surgeons
American Urological Association
Association for Professionals in Infection Control and Epidemiology
Association for the Advancement of Wound Care
Association of periOperative Registered Nurses
Association of Rehabilitation Nurses
Association of Women's Health, Obstetric and Neonatal Nurses
Council of Medical Specialty Societies
Heart Rhythm Society
Hospice and Palliative Nurses Association
Infectious Diseases Society of America
Infusion Nurses Society
National Academy of Clinical Biochemistry
National Alliance of Wound Care
National Association for Behavioral Health
National Association of Certified Professional Midwives
National Association of Pediatric Nurse Practitioners
National Nursing Staff Development Organization
National Pressure Ulcer Advisory Panel
New York University College of Nursing
Nursing Alliance for Quality Care
Ohio Hospice & Palliative Care Organization
Renal Physicians Association
Society for Academic Emergency Medicine
Society for Cardiovascular Angiography and Interventions
Society for Healthcare Epidemiology of America
Society for Vascular Surgery
Society of Critical Care Medicine
Society of General Internal Medicine
Society of Hospital Medicine
Society of Thoracic Surgeons
Wisconsin Medical Society
Wound, Ostomy and Continence Nurses Society

Provider Council

Adventist Health System
Advocate Physician Partners
Ambulatory Surgery Foundation
Amedisys
American Health Care Association
American Hospital Association
AmSurg Corp.
Ascension Health
Association for Behavioral Health and Wellness
Association of American Medical Colleges
Atlantic Health
Aultman Health Foundation
Aurora Health Care
Baptist Health South Florida
Baptist Memorial Health Care Corporation
BayCare Health System
Baylor Health Care System
BJC HealthCare
Bon Secours St. Francis Health System
Bronson Healthcare Group, Inc.
California Hospital Association
CaroMont Health
Catholic Health Association of the United States
Catholic Health Initiatives
Catholic Healthcare Partners
Cedars-Sinai Medical Center
Child Health Corporation of America
Children's Hospitals and Clinics of Minnesota
CIMPAR, S.C.
City of Hope
Cleveland Clinic
Connecticut Hospital Association
Crozer-Keystone Health System
Dana-Farber Cancer Institute
Detroit Medical Center
DMAA: The Care Continuum Alliance
Emergency Department Practice Management Association
Englewood Hospital and Medical Center
Exeter Health Resources
Federation of American Hospitals
Florida Hospital
Fox Chase Cancer Center
Genesis HealthCare System
Gentiva Health Services
Good Samaritan Hospital
H. Lee Moffitt Cancer Center and Research Institute Hospital, Inc.
Hackensack University Medical Center
Harborview Medical Center
Health Management Associates, Inc.
Healthcare Leadership Council
HealthPartners
HealthSouth Corporation
Henry Ford Health System
Hoag Hospital
Hospital Corporation of America
Hospital for Special Surgery
Illinois Hospital Association
Interim HealthCare Inc.
Johns Hopkins Health System
LHC Group, Inc.
Long-Term Quality Alliance
MaineGeneral Medical Center
Mayo Clinic
MedStar Health
Memorial Hermann Healthcare System
Memorial Sloan-Kettering Cancer Center
Mercy Medical Center
Meridian Health System
Mission Hospital, Inc.
National Association of Children's Hospitals and Related 
Institutions
National Association of Psychiatric Health Systems
National Association of Public Hospitals and Health Systems
National Consortium of Breast Centers
National Hospice and Palliative Care Organization
National Rural Health Association
NCH Healthcare System
Nemours Foundation
New Jersey Hospital Association
New York Presbyterian Healthcare System
North Mississippi Medical Center
North Shore-Long Island Jewish Health System
North Texas Specialty Physicians
Northwestern Memorial HealthCare
Norton Healthcare, Inc.
OSUCCC-James Cancer Hospital
Park Nicollet Health Services
Partners HealthCare System, Inc.
Pennsylvania Health Care Association
Piedmont Healthcare
Planetree
Premier, Inc.
Providence Health & Services
Robert Wood Johnson University Hospital-Hamilton
Rockford Health System
Roswell Park Cancer Institute
Rush University Medical Center
Saint Barnabas Health Care System
Saint Francis Hospital and Medical Center
Seattle Cancer Care Alliance
Sharp HealthCare
Sisters of Charity of Leavenworth Health System
Sisters of St. Francis Health Services
Southeast Texas Medical Associates, LLP
Stamford Health System
Summa Health System
Surgical Care Affiliates

[[Page 55497]]

Sylvester Comprehensive Cancer Center, University of Miami Hospitals 
and Clinics
Tampa General Hospital
Tenet Healthcare Corporation
Texas Health Resources
The Alliance for Home Health Quality and Innovation
The Health Alliance of Mid America LLC
The National Forum of ESRD Networks
The University of Kansas Hospital
Thomas Jefferson University Hospital
Trinity Health
UMass Memorial Medical Group, Inc.
United Surgical Partners International
University of California-Davis Medical Group
University of Michigan Hospitals & Health Centers
University of Pennsylvania Health System
University of Texas Southwestern Medical Center
University of Texas-MD Anderson Cancer Center
University of Virginia Health System
US Department of Defense-Health Affairs
UW Health
Vanderbilt University Medical Center
Vanguard Health Management
Veterans Health Administration
VHA, Inc.
Virginia Mason Medical Center
Virtua Health
WellSpan Health
WellStar Health System
Yale New Haven Health System

Public/Community Health Agencies Council

Albuquerque Coalition for Healthcare Quality
Aligning Forces for Quality--South Central Pennsylvania
Alliance for Health
Better Health Greater Cleveland
California Office of Statewide Health Planning and Development
Center for Health Care Quality, Department of Health Policy, George 
Washington University
Centers for Disease Control and Prevention
Central Indiana Alliance for Health
Community Health Alliance-Humboldt County Del-Norte
Greater Detroit Area Health Council
Health Improvement Collaborative of Greater Cincinnati
Health Resources and Services Administration
Healthy Memphis Common Table
Illinois Department of Public Health
Integrated Healthcare Association
Kansas City Quality Improvement Consortium
Maine Quality Forum
Maryland Health Care Commission
Massachusetts Health Quality Partners
Middlesex Hospital
Minnesota Community Measurement
National Academy for State Health Policy
National Association of Health Data Organizations
Oregon Health Care Quality Corporation
P2 Collaborative of Western New York
Puget Sound Health Alliance
Quality Counts
Rhode Island Department of Health
State Associations of Addiction Services
Substance Abuse and Mental Health Services Administration
The HOPE of Wisconsin
Washington State Department of Health
Wisconsin Collaborative for Healthcare Quality

Purchaser Council

Buyers Health Care Action Group
Caterpillar Inc.
Centers for Medicare & Medicaid Services
Colorado Business Group on Health
Employers' Coalition on Health
Florida Health Care Coalition
General Motors Corporation
Health Action Council Ohio
Health Services Coalition
HealthCare 21 Business Coalition
Lehigh Valley Business Coalition on Health Care
Maine Health Management Coalition
Microsoft Corporation
National Association of State Medicaid Directors
National Business Coalition on Health
National Business Group on Health
New Jersey Health Care Quality Institute
Niagara Health Quality Coalition
Pacific Business Group on Health
St. Louis Area Business Health Coalition
The Alliance
The Leapfrog Group
Virginia Business Coalition on Health
Washington State Health Care Authority

QMRI Council

AAAHC Institute for Quality Improvement
ABIM Foundation
ACC/AHA Task Force on Performance Measures
ACS-MIDAS+
Agency for Healthcare Research and Quality
American Academy of Nursing
American Association of Colleges of Nursing
American Board of Medical Specialties
American Board of Optometry
American College of Medical Quality
American Data Network
American Health Quality Association
American Medical Association-Physician Consortium for Performance 
Improvement
American Medical Informatics Association
American Psychiatric Association for Research and Education
Anesthesia Quality Institute
AYR Consulting Group
Betsy Lehman Center for Patient Safety and Medical Error Reduction
BoozAllenHamilton
California HealthCare Foundation
California Maternal Quality Care Collaborative
Case Management Society of America
Center to Advance Palliative Care
Community Health Accreditation Program
Coral Initiative, LLC
Core Consulting, Inc.
Dallas-Fort Worth Hospital Council Education and Research Foundation
Freedman HealthCare, LLC
Health Level Seven, Inc
Health Services Advisory Group
Healthcare Information and Management Systems Society
HealthGrades
Institute for Clinical Systems Improvement
Institute for Safe Medication Practices
Iowa Foundation for Medical Care
Iowa Healthcare Collaborative
IPRO
Jefferson Health System, Office of Health Policy and Clinical 
Outcomes
Kidney Care Partners
Louisiana Health Care Quality Forum
Medisolv, Inc.
MHA Keystone Center for Patient Safety & Quality
Milliman Care Guidelines
National Association for Healthcare Quality
National Center for Healthcare Leadership
National Committee for Quality Assurance
National Consensus Project for Quality Palliative Care
National Council of State Boards of Nursing
National Institute for Quality Improvement and Education
National Institutes of Health
National Patient Safety Foundation
Neocure Group
Next Wave
North Carolina Center for Hospital Quality and Patient Safety
Northeast Health Care Quality Foundation
Partnership for Prevention
Pharmacy Quality Alliance
Press Ganey Associates
Professional Research Consultants, Inc.
Quality Indicator Project
Quality Outcomes, LLC
Resolution Health, Inc.
Texas Medical Institute of Technology
The Commonwealth Fund
The Joint Commission
Thomson Reuters
University HealthSystem Consortium
University of Kansas School of Nursing
University of North Carolina-Program on Health Outcomes
URAC
Verilogue, Inc
Virginia Cardiac Surgery Quality Initiative
West Virginia Medical Institute

Supplier/Industry Council

Abbott Laboratories
AMGEN Inc.
Arrowsight, Inc.
AstraZeneca
Boehringer Ingelheim
Bristol-Myers Squibb Company
CareFusion
Deloitte Consulting LLP, Health Sciences and Government
Dialog Medical
Edwards Lifesciences
eHealth Initiative
Eisai, Inc.
Eli Lilly and Company
Elsevier Clinical Decision Support
Epstein Becker & Green, P.C.
GE Healthcare
GlaxoSmithKline
Greenway Medical Technologies
Hospira
MedAssets
MedeAnalytics, Inc.
Merck & Co., Inc
Noblis
Ortho-McNeill-Janssen Pharmaceutical, Inc.
Pfizer
PhRMA
Phytel, Inc.
sanofi pasteur
sanofi-aventis

[[Page 55498]]

Siemens Healthcare, USA
The Advanced Medical Technology Association (AdvaMed)
Zynx Health

Acknowledgments

    The National Quality Forum wishes to acknowledge the invaluable 
editorial services of Philip Dunn and the design expertise of Corporate 
Visions, Inc. This report was printed by MOSAIC Print.

IV. Secretarial Comments on the Annual Report to Congress

    The Secretary is pleased with the scope and vision of NQF's March 
2011 annual report to Congress (the ``annual report''). An internal 
multidisciplinary HHS team is working collaboratively with NQF to 
provide a clear multi-year vision to ensure the most efficient and 
effective utilization of the HHS contract. The contract with NQF 
provides a unique opportunity to further enhance HHS' efforts to foster 
a collaborative, multi-stakeholder approach to increase the 
availability of national voluntary consensus standards for quality and 
efficiency measures that can help to ensure broad transparency in 
achieving value in health care delivery.
    Over the past year NQF continued work on tasks outlined in the 
Statement of Work, including: development of a national strategy for 
performance measurement and prioritization of measures for development 
and endorsement; evaluation of NQF's consensus development process; 
conduct of measure endorsement projects focused on areas where there 
are gaps in measures, such as outcomes measures and patient safety 
measures; maintenance of current NQF-endorsed measures; and promotion 
of Electronic Health Records through such activities as developing a 
measure authoring software tool, initiation of a taxonomy and rules for 
clinical decision support that are in accord with the Quality Data 
Model, retooling of a subset of existing NQF-endorsed measures into 
electronic measure format, development of a public Web site to make 
available current NQF activities, and development of evaluation 
criteria for the endorsement of efficiency and resource use measures. 
In response to a time-sensitive Affordable Care Act requirement, a new 
short-term task was added for NQF to provide input into the national 
priorities for consideration under for the National Strategy Quality 
for Improvement in Healthcare. The NQF convened the National Priorities 
Partnership (NPP) and delivered a report that provided actionable input 
for improvement in population health and in the delivery of health care 
services.
    The Secretary has reviewed the annual report and has the following 
comments. First, the Secretary notes an inadvertent statement in the 
annual report that appears at the end of the second paragraph in the 
section entitled ``II. About the National Quality Forum''. It refers to 
the Consensus Development Process (CDP) and states that ``strict 
adherence to this CDP qualifies NQF as a voluntary consensus standards-
setting organization, granting its endorsed measures special legal 
standing''. The CDP qualifies the NQF as a voluntary consensus 
standards-setting organization, and therefore, the endorsed measures 
are granted standing as voluntary consensus standards. The endorsed 
measures are not granted special legal standing. This same issue also 
arises in the section entitled ``III. About the Contract'' in the 
second bullet following the third paragraph. The sentence includes the 
statement that the CDP grants the ``measures and practices special 
legal standing as voluntary consensus standards''. The CDP grants the 
measures and practices standing as voluntary consensus standards, but 
does not grant the measures special legal standing.
    Second, the Secretary wishes to clarify a statement that has the 
potential to be misleading. This statement is included in the annual 
report's section entitled ``II. About the National Quality Forum''. It 
appears in the third sentence of the sixth paragraph. This sentence 
mischaracterizes the quality programs described. In particular, CMS is 
not ``measuring'' meaningful use for purposes of the EHR program. 
Rather, if eligible professionals and hospitals are able to demonstrate 
that they meet the requisite meaningful use criteria, they will receive 
an incentive payment. In addition, Hospital Compare is an internet Web 
site on which the performance of certain providers is reported; it is 
not a quality reporting program. The correct reference is to the 
Medicare Inpatient Quality Reporting program.
    Third, the Secretary wishes to clarify a statement in the 
subsection entitled ``Implementation of a Consensus Process for the 
Endorsement of Quality Measures (Task 7)'' in the section entitled 
``IV. HHS-Funded Work''. The fourth sentence in the first bullet point 
under the heading ``Patient Safety'' within that subsection could be 
misleading. It states: ``Serious Reportable Events has become the 
foundation of HHS's program of denial of payment for certain hospital-
acquired conditions and for many state based adverse event reporting 
initiatives.'' This sentence could be interpreted to mean that the 
NQF's list of serious reportable events is the only basis for HHS's 
denial of payment for certain hospital-acquired conditions, which is 
inaccurate.
    Fourth, a sentence in the subsection entitled ``Technical 
Infrastructure to Support Measurement Using an Electronic Platform'' 
within the section entitled ``I. Executive Summary'' states that the 
American Recovery and Reinvestment Act of 2009 (ARRA) ``provides $20 
billion for investment in health IT and use of that technology to 
improve patient care.'' Similarly, a sentence in the subsection 
entitled ``Promotion of Electronic Health Records (Task 9)'' within the 
section entitled ``IV. HHS-Funded Work'' states that ARRA ``provides a 
$20 billion mandate to ensure health IT plays a central role in 
transforming the EHR Incentive Program and its meaningful use 
provisions * * *.'' ARRA does not specify an amount of funding for the 
EHR Incentive Program. The final amount will depend on the numbers of 
providers and professionals that participate in the program and their 
specific years of participation. ARRA also appropriated $2 billion for 
the Office of the National Coordinator for Health Information 
Technology (ONC).
    Finally, the information describing Task 9.7 (Measure retooling for 
EHRs) in Appendix A; Summary of Accomplishments Under the Contract: 
Jan. 14, 2010 to Jan. 12, 2011 warrants further clarification. During 
the reporting period, the specifications for 113 measures were drafted 
and updated. They are undergoing review and public comment and will be 
further updated by December 2011. The Web site where the measures and 
eSpecifications were posted for public comment is included in Appendix 
A.
    The Secretary is pleased with the progress and timeliness of the 
work outlined in the Annual Report.

V. Future Steps

    The consensus-based contract with NQF is a four year contract. 
During this second full performance year of the contract, NQF completed 
deliverables for each task required by MIPPA and for the short-term 
requirements of section 3014 in ACA. HHS will continue to task NQF with 
single year and multi-year projects.

Formulation of a National Strategy and Priorities for Health Care 
Performance Measurement

    During March 2010 to February 2011, NQF recommended eight priority 
areas for national action to the Department for the National Health 
Care Quality

[[Page 55499]]

Strategy. Two were new: To ensure all patients have access to 
affordable, timely and high quality care; and to provide infrastructure 
supports, such as health IT, to address underlying system changes that 
are necessary to attain the goals of other priorities. The original six 
priorities were: Patient and family engagement; population health; 
safety; care coordination; palliative and end-of-life care; and overuse 
of resources. During the year NQF continued its work on the 
requirements of MIPPA section 183.
    The NQF Prioritization Measure Advisory Committee continued to 
explore priorities for health care performance measurement and 
developed a list of 20 prioritized high-impact Medicare conditions and 
measurement gaps. These conditions account for more than 90 percent of 
Medicare costs. This work complemented the NPP's additional focus on 
``cross-cutting'' areas which affect all or most patients, such as care 
coordination.

Consensus Development Process for Measure Development

    The NQF portfolio includes 625 measures organized into five major 
categories of quality health care: Patient outcomes; care processes; 
patient experience; resource use; and composite measures. The measures 
are used in a variety of provider settings, such as ambulatory care 
settings, emergency service settings and nursing homes, which operate 
with different data reporting platforms. To meet the various platform 
needs, measures need to accommodate paper records, and administrative 
and claims data. During the year, additional work focused on the 
endorsement of measures of the 20 high-impact Medicare conditions as 
well as measures for patient safety, nursing homes and child health. 
Simultaneously, the NQF conducted reviews for potential endorsement of 
62 measures that fit into the five categories above.

Maintenance of Consensus-Based Endorsed Measures

    During March 2010 to February 2011, NQF maintained endorsed 
measures relevant to HHS-wide programs and will continue to maintain 
consensus-based endorsed measures as developed under the priority 
process.

Promotion of Electronic Health Records

    During March 2010 to February 2011, NQF continued to support the 
promotion of electronic health records as part of HHS-wide efforts. 
NQF's contributions during the year focused on four areas: (1) 
Enhancement of the Quality Data Model, which specifies the necessary 
data for electronic and personal health records; (2) standardization of 
eMeasure format for use by more than 50 measure developers; (3) re-
specification of a subset of performance measures into eMeasures for 
use with electronic health records; and (4) identification of types of 
measures for use in determining whether clinicians are properly using 
electronic health records as well as to detect any unintended 
consequences. Initial work was undertaken during the year to 
incorporate the eMeasure format into a Measure Authoring Tool.

Focused Measure Development, Harmonization, and Endorsement Efforts To 
Fill Critical Gaps in Performance Measurement

    During March 2010 to February 2011, NQF continued to support a 
variety of performance measurement efforts focused on efficiency, 
harmonization, the ICD-10 and regionalized emergency care services. 
Both harmonization and ICD-10 activities that were specified for work 
were complete within the year. NQF made progress in the area of 
efficiency with two tasks nearing completion and another undertaken 
during the year. NQF also initiated work on regionalized emergency care 
services mid-way through the year and progress in that area continues.
    During the next contract year, NQF will focus its work on 
fulfilling the requirements of ACA section 3014 in addition to the 
continuation of work as required under MIPPA. NQF will also undertake 
work to provide further input into the annual National Quality Strategy 
and selection of quality measures for use in public and private 
reporting programs and value-based purchasing programs. This work will 
be included in subsequent annual reports.

V. Collection of Information Requirements

    This document does not impose information collection and 
recordkeeping requirements. Consequently, it need not be reviewed by 
the Office of Management and Budget under the authority of the 
paperwork Reduction Act of 1995 (44 U.S.C. 35)

    Dated: August 26, 2011.
Kathleen Sebelius,
Secretary, Department of Health and Human Services.
[FR Doc. 2011-22624 Filed 9-6-11; 8:45 am]
BILLING CODE 4150-05-P