Challenges, Promises for Health Care Quality Measurement
In our quest to improve health care, a consensus is emerging about the need to measure quality and to pay more for value and less for volume. Secretary Sylvia Burwell announced in January that HHS intends to link 85 percent of Medicare payments to quality or value by 2016 and 90 percent by 2018. Another HHS goal: to have 30 percent of Medicare payments go through alternative payment models, such as Accountable Care Organizations or bundled payment arrangements, by the end of 2016 and 50 percent by the end of 2018.
We’ve relied too long on payment systems that do not measure or reward quality. Too often, these systems have delivered care whose value has been uncertain, not adequately responsive to patient preferences, and not sufficiently devoted to improving safety.
In light of this, AHRQ and the National Quality Forum (NQF) recently convened a meeting of 23 leaders in the health care quality field to discuss the best ways to grow and support the field of quality measurement. The take-aways from this meeting, which NQF CEO Christine K. Cassel, M.D., and I wrote about in viewpoint published in the September 1 issue of the Journal of the American Medical Association (JAMA), included the following:
- Align measures. We need to ensure that clinicians consistently focus on things that matter to patients and clinicians. NQF, the Centers for Medicare & Medicaid Services (CMS), and America’s Health Insurance Plans are working together to align measures across payers.
- Support internal improvement. The current emphasis on external incentives, such as paying for quality, neglects providers’ inherent motivation to provide the best care possible. There are many examples of rapid improvements occurring in the absence of financial incentives. Supporting local quality improvement efforts and providing feedback on performance may be at least as important as the current emphasis on payment and accountability.
- Collaborate with users in the development of measures. Performance measures must be meaningful to clinicians, purchasers, and patients. To help achieve this goal, CMS encourages the use of patient representatives in its measurement development contracts. Further, we need better lines of communication between those who develop and review measures and those who use them at the point of care. This is vital to see what is working and to identify flaws so that measures may be modified or used in a different way.
There has been significant progress in our efforts to measure desired outcomes over the past 15 years. But challenges continue related to our ability to measure important concepts—such as diagnostic accuracy, meaningful involvement of patients in decision making, and care coordination. It is important to ensure that the time and energy required to fulfill the current measurement requirements is well spent and produces useful information for improvement.
I look forward to working with others in the field to find solutions and to work toward a future in which all health care is safe and provides good outcomes that are valued by patients, clinicians, and policymakers. In fact, one example of an improved measurement system that AHRQ is testing, the Quality and Safety Review System, is envisioned as an enhanced replacement for the Medicare Patient Safety Monitoring System that is currently used to measure the national rate of hospital-acquired conditions. Although we have had good news to share regarding the nation’s progress toward making care safer, patients are still being harmed far too frequently while receiving health care.
As with all safety and quality measurement efforts, the Agency’s goal is to support the field by providing reliable information to guide further improvement.
Richard Kronick, Ph.D., is Director of the Agency for Healthcare Research and Quality.
Page originally created September 2015