Secretarial Review and Publication of the Annual Report to Congress Submitted by the Contracted Consensus-Based Entity Regarding Performance Measurement, 65340-65349 [2010-26795]
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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
Office of the Secretary of
Health and Human Services, HHS.
ACTION: Notice.
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AGENCY:
This notice acknowledges 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
SUMMARY:
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regarding performance measurement as
mandated by section 183 of the
Medicare Improvements for Patients and
Providers Act of 2008 (MIPPA). The
statute requires HHS to publish not later
than six months after receiving the
annual report to Congress in the Federal
Register together with any Secretarial
comments.
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.
Congress mandated the Secretary of the
Department of Health and Human
Services (HHS) to contract with a
consensus-based entity regarding
performance measurement to support
HHS’ efforts to achieve value as a
purchaser of high-quality, patient-
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responses per
respondent
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burden hours
per response
30/60
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burden
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60
centered, and financially sustainable
health care. Section 183 of the Medicare
Improvements for Patients and
Providers Act of 2008 (MIPPA) added
section 1890 to the Social Security Act
(the Act). The statute mandates that the
contract shall be competitively awarded
for a period 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’
contract activities, if applicable.
The HHS four-year contract with NQF
includes the following major tasks:
Formulation of National Strategy and
Priorities for Health Care Performance
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Measurement—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 decisions;
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—At the
request and direction of HHS, 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 website to provide access to
project documents and processes. The
HHS contract work is found at: https://
www.qualityforum.org/projects/
ongoing/hhs/.
Annual Report to Congress and the
Secretary—Under section 1890(b)(5)(A)
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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 task; 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, as created by
section 183 of MIPPA, 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,
the first annual 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 Secretary of HHS the
second annual report. This notice
complies with the statutorily required
Secretarial review and publication of
the second annual report covering the
period of performance of March 1, 2009
through February 28, 2010.
II. March 2010—NQF Report to
Congress and HHS Secretary
Submitted in March 2010, the second
annual report to Congress and the
Secretary spans the period of March 1,
2009 through February 28, 2010.
A copy of NQF’s submission of the
March 2010 annual report to Congress
and the Secretary of HHS can be found
at: https://www.qualityforum.org/
projects/ongoing/hhs/.
The 2010 NQF annual report is
reproduced in section III of this notice.
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III. NQF March 2010 Annual Report
Strengthening the National Quality
Infrastructure National Quality Forum
Accomplishments Under Contract
#HHSM–500–209–00010C
Report to the Congress and the
Secretary of the U.S. Department of
Health and Human Services, Covering
the period of March 1, 2009, to February
28, 2010, Pursuant to PL 110–275 and
Contract #HHSM–500–209–00010C
Table of Contents
A Message From the Leadership of the
National Quality Forum Executive
Summary
About the Contract
Work Performed by the National Quality
Forum Under the DHHS Contract in 2009
2010 and Beyond: A Look Ahead
Appendices and Notes
Appendix A: About NQF
Appendix B: NQF Board of Directors
Appendix C: NQF Key Staff
Appendix D: National Priorities Partnership
Notes
The mission of the National Quality
Forum is to improve the quality of
American healthcare by setting national
priorities and goals for performance
improvement, endorsing national
consensus standards for measuring and
publicly reporting on performance, and
promoting the attainment of national
goals through education and outreach
programs.
A Message From the Leadership of the
National Quality Forum
Ten years ago, the Institute of
Medicine (IOM) exposed the U.S.
healthcare system’s numerous quality
and patient safety deficiencies with the
publication of its landmark report, To
Err is Human.1 In the decade since,
numerous local, regional, and national
quality improvement initiatives,
including but not limited to programs
supported by the federal and state
governments, have sought to correct
these deficiencies. Many of these
activities have borne fruit. Some can
definitively be credited with saving
American lives.
Despite these successes, and despite
the dedicated effort of millions of welltrained, committed, and compassionate
healthcare workers, the quality of
healthcare in the United States still is
not nearly as good as it could or should
be. Thousands of Americans die every
year, and millions more are injured, as
a result of medical error. Processes of
care vary widely by region, state, and
provider, with no apparent benefit to
patients. Healthcare in the United States
is plagued by inequities based on race,
ethnicity, gender, and other factors.
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Costs—including costs to taxpayers—
have skyrocketed. Millions of
Americans are denied access to care
because they lack sufficient insurance.
As the decade progressed, it became
clear that the nation’s numerous quality
initiatives, successful though many may
have been, were no substitute for a
coordinated national strategy to
systematically improve the quality of
healthcare in the United States. To help
formulate such a strategy, Congress in
2008 passed the Medicare
Improvements for Patients and
Providers Act (Pub. L. 110–275).2 One
goal of the legislation is to establish a
portfolio of quality and efficiency
measures that will allow the federal
government to see more clearly how and
whether public healthcare spending is
achieving the best results for Americans.
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 (DHHS) ‘‘to contract with a
consensus-based entity, such as the
National Quality Forum.’’ This report
summarizes the work performed under
this contract between March 1, 2009,
and February 28, 2010, the first full year
that the DHHS contract has been in
place.
As we review the work performed
over the past year, it becomes apparent
that 2009 was a year of building
infrastructure to support healthcare
quality. Much like physical
infrastructure, the nation’s healthcare
quality infrastructure must be
constructed with precise attention to
detail, and then maintained so that it
meets the expanding needs of those it
serves. Priorities and goals must be
identified to focus improvement efforts
on areas that will yield the greatest
gains in terms of improved health and
healthcare; and performance measures
must be developed, endorsed, and
implemented to gauge delivery system
progress and reveal opportunities for
improvement.
Many of the activities NQF has
performed under the DHHS contract are
in midstream and extend beyond a
single year’s worth of work.
Nevertheless, we have completed
significant work in several areas,
including:
• The development of a prioritized
set of conditions for quality
improvement;
• The endorsement of performance
measures in critical gap areas; and
• The establishment of common
protocols and standardized formats for
e-measure specification and the creation
of an electronic measure authoring
environment to enable retooling of
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performance measures for the
assessment of ‘‘meaningful use’’ of
health information technology (HIT).
We are grateful to Congress and DHHS
for supporting NQF’s work in nurturing
the quality enterprise in the United
States; to the more than 400
institutional members of NQF who have
sustained the organization and, in doing
so, have helped build the healthcare
quality improvement movement; and to
NQF’s expert panel volunteers and staff,
whose tireless efforts on behalf of
American patients contribute to a
healthcare system that is becoming, as
the IOM envisioned, safe, timely,
effective, efficient, equitable, and
patient centered.
During the last year, we built a
stronger foundation for healthcare
performance improvement in the United
States. We are confident that in 2010
and beyond, Americans will reap the
benefits of our healthcare quality
infrastructure.
1. Executive Summary
The National Quality Forum (NQF)
was created in 1999 to develop and
implement a national strategy for
healthcare quality improvement. It has
grown into an influential consensusbased organization in healthcare in the
United States, supported by more than
400 organizational members and
boasting a unique structure that enables
private and public sector stakeholders to
collaborate on cross-cutting solutions to
drive continuous performance
improvement. NQF’s core work includes
the establishment of national priorities
and the endorsement of performance
measures. NQF follows a formal
Consensus Development Process
recognized under the National
Technology Transfer and Advancement
Act of 1995 (Pub. L. 104–113), which
grants its endorsed measures and best
practices special legal standing as
national voluntary consensus standards.
Section 183 of the Medicare
Improvements for Patients and
Providers Act (Pub. L. 110–275) of 2008
calls for the Department of Health and
Human Services (DHHS) ‘‘to contract
with a consensus-based entity, such as
the National Quality Forum’’ (NQF) for
the purpose of pursuing certain
activities relating to healthcare
performance measurement. On January
14, 2009, the National Quality Forum
was awarded a contract under this
Section. The contract provided up to
$10 million for the first year after award
with the option for three $10 million
annual renewals. Among other
assignments, the contract called for NQF
to:
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• Develop a prioritized list of
conditions that impose heavy health
burden on beneficiaries and account for
significant costs;
• Identify and endorse measures that
can be used by various stakeholders to
assess and improve the care provided to
beneficiaries with these conditions, and
the performance of providers in various
healthcare settings; and
• Promote the use of electronic health
records (EHRs) for performance
measurement, reporting, and
improvement.
This report summarizes the work
performed under this contract between
March 1, 2009, and February 28, 2010,
the first full year that the DHHS contract
has been in place.
Many of the activities NQF has
performed under the DHHS contract are
in midstream and extend beyond a
single year’s worth of work. Under the
DHHS contract, NQF has achieved
significant accomplishments in the
following areas:
• Developed a framework, composed
of the 20 priority conditions for
Medicare and the six cross-cutting
priority areas identified by the NQFconvened National Priorities
Partnership, for focusing performance
measurement, public reporting, and
improvement efforts;
• Conducted an environmental scan
of existing performance measures and
measures under development, and
began constructing a prioritized agenda
for measure development and
endorsement;
• Initiated endorsement projects to
expand the portfolio of NQF-endorsed®
measures in key gap areas: Patient
outcomes, efficiency, patient safety, and
nursing home care;
• Enhanced processes for ongoing
‘‘measure maintenance’’ to ensure that
the more than 550 measures that NQF
already has endorsed are continuously
updated to reflect changes in the
evidence base as it evolves and undergo
comprehensive assessment on a threeyear cycle to maintain ‘‘best in class’’
standing;
• Contracted with an applied research
firm to conduct an independent
evaluation of its Consensus
Development Process;
• Began work on a two-year plan for
the evolution of NQF’s portfolio of
endorsed patient safety measures, ‘‘safe
practices,’’ and serious reportable
events;
• Undertook an environmental scan
to review the state of reporting with
respect to patient safety events and
serious reportable events at the federal
and state level;
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• Completed an evaluation of the
types of data that must be captured in
electronic health records (EHRs) to
support measurement and improvement
on the more than 550 NQF-endorsed
performance measures;
• Developed a standardized format
(i.e., the Health Quality Measure
Format) for representing a health quality
measure in a machine-readable
electronic format, which has now been
approved by HL7 for use in EHRs; and
• Produced an enhanced Web site,
featuring an online performance
measure submission form, an improved
online platform for public comment,
and an online directory of NQFendorsed consensus standards.
Much like physical infrastructure, the
nation’s Healthcare quality
infrastructure must be constructed with
precise attention to detail, and then
maintained so that it meets the
expanding needs of those it serves. In
2009, under the DHHS contract, NQF
took great strides in building and
supporting that infrastructure. In 2010
and beyond, the United States will reap
significant benefits from investments in
this quality infrastructure, which is
critical to support expanded public
reporting and payment reform and foster
continuous quality improvement in
American healthcare.
2. 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.
Section 183 of the Act, among other
things, directs the Secretary of DHHS 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–500–209–
00010C, under Section 183 of the
Medicare Improvements for Patients and
Providers Act. The DHHS contract is
administered by the Office of the
Assistant Secretary for Planning and
Evaluation (ASPE), which provides
strategic leadership and technical
insight for the contract, and by the
Centers for Medicare & Medicaid
Services (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 called for
NQF to:
• Develop a prioritized list of
conditions that impose heavy health
burden on beneficiaries and account for
significant costs;
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• Identify and endorse measures that
can be used by various stakeholders 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.
While the work conducted under the
contract is intended specifically to
benefit all those served by DHHS
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 and
recent accomplishments in three areas:
• Setting 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.
• Endorsing performance measures.
NQF has endorsed more than 500
performance measures and best
practices under its formal Consensus
Development Process, granting those
measures and practices special legal
standing as voluntary consensus
standards.
• Facilitating the development of
EHRs to support measurement and
improvement. NQF has worked to
identify the types of information that
need to be included in an EHR to enable
reporting on quality metrics.
Under the contract, DHHS 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 be attributable to
providers where possible. A premium
must be placed on developing measures
in key areas that will have the greatest
impact in improving quality and value,
rather than focusing on developing a
large number of measures that may be
easiest to produce, such as process
measures.’’
The contract is divided into 12 tasks.
Six of the tasks are procedural—
involving an opening meeting, the
development of a work plan, the
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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 six 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 the endorsement of healthcare
quality measures. Task 7 includes an
evaluation of NQF’s Consensus
Development Process and the conduct
of consensus 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. Task 12 is divided into
three subtasks: Efficiency,
harmonization, and ICD–10.
Details of work performed under the
DHHS contract in each of these tasks are
found in Section 3 of this report.
3. Work Performed by the National
Quality Forum Under the DHHS
Contract in 2009
This section describes details of work
performed under each task according to
the DHHS contract in the past year.
National Strategy and Priorities (Task 6)
A two-dimensional framework—
consisting of leading conditions and
cross-cutting areas—has been developed
to focus performance measurement and
improvement on high-leverage areas
having the greatest potential to improve
health and healthcare. Starting with the
Medicare 20 priority conditions, which
collectively account for 95 percent of
Medicare expenditures (see Exhibit A),
an expert panel is working to prioritize
these conditions based on cost,
prevalence, improvability, variability,
and disparities. The second part of the
strategy builds on work previously
performed by the National Priorities
Partnership,3 32 major national
healthcare stakeholder organizations
(see Appendix D) convened by NQF,
which identified six crosscutting
priority areas that affect many
conditions: Patient and family
engagement, population health, safety,
care coordination, palliative and end-oflife care, and overuse.4 To identify gaps,
currently available performance
measures have been mapped to this
framework.
To further inform the process of
setting an agenda for measure
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development and endorsement, NQF is
convening experts and gathering
information to identify specific types of
measures needed to support Medicare
payment and public reporting programs,
‘‘meaningful use’’ of HIT, and other
applications. This work is scheduled for
completion in the third quarter of 2010.
Exhibit A: Medicare 20 Priority
Conditions
To assist in carrying out its
responsibilities, in 2009 NQF issued a
firm, fixed-price contract for a qualified
contractor to perform a systematic
review and synthesis of evidence
relating to 20 high-priority conditions
identified by the Centers for Medicare &
Medicaid Services. Patients with these
conditions account for more than 95
percent of Medicare’s costs. The 20
conditions (not in any order of priority)
are:
• Acute myocardial infarction
• Alzheimer’s disease and related
disorders
• Atrial fibrillation
• Breast cancer
• Cataract
• Congestive heart failure
• Chronic kidney disease
• Colorectal cancer
• Chronic obstructive pulmonary
disorder
• Diabetes
• Endometrial cancer
• Glaucoma
• Hip/pelvic fracture
• Ischemic heart disease
• Lung cancer
• Major depression
• Osteoporosis
• Prostate cancer
• Rheumatoid arthritis and
osteoarthritis
• Stroke/transient ischemic attack
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Consensus Development Process for
Measure Endorsement (Task 7)
The stakeholder-based endorsement
of performance measures via a formal
Consensus Development Process (CDP)
has long been NQF’s ‘‘stock in trade.’’
This task involves both a formal
evaluation of the endorsement process
and the conduct of a set of endorsement
projects focused on known measure gap
areas.
Evaluation of the Consensus
Development Process. NQF follows a
nine-step process (Exhibit B) to evaluate
and endorse consensus standards,
including performance measures,
serious reportable events, best practices,
measurement frameworks, and reporting
guidelines. The process is designed to
ensure that performance measures
endorsed by NQF satisfy certain criteria
(i.e., importance, scientific
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acceptability, usability, and feasibility)
and represent the ‘‘best in class.’’ The
process is transparent and provides for
extensive input from all stakeholders.
Over the past 10 years, the steps that
form NQF’s Consensus Development
Process and its implementation have
evolved to ensure that evaluation of
Candidate Consensus Standards
continues to follow best practices in
performance measurement and
standards setting. In 2009, under the
DHHS contract, NQF contracted with
Mathematica Policy Research Inc. to
conduct an independent evaluation of
the Consensus Development Process.
This evaluation also includes gathering
information on similar processes of
other standard-setting bodies, which is
expected to be useful in further refining
NQF’s endorsement process. This report
is scheduled for completion in October
2010, with the proposed enhancements
to the Consensus Development Process
scheduled to be considered in January
2011.
Exhibit B: NQF Consensus Development
Process (Version 1.8)
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 Decision.
8. Board Ratification.
9. Appeals.
Endorsement Projects. The current
DHHS contract facilitates a coordinated,
strategic approach to endorsing
performance measures.
As noted above, efforts are underway
to develop a comprehensive agenda for
measure development and endorsement,
which will guide future endorsement
work. During this first year of the DHHS
contract, the schedule of endorsement
projects was determined though a
collaborative process involving
representatives from the various DHHS
departments and NQF, targeting wellknown gap areas. On average, it takes
less than one year to complete the ninestep Consensus Development Process.
Endorsement projects fall into two
broad categories: Quality and efficiency,
and patient safety.
Quality and Efficiency. Many projects
in this area focus on measures of patient
outcomes and efficiency, thus laying the
groundwork for assessing the ‘‘value’’
received from healthcare services.
Considerable attention also is paid to
settings outside the hospital and to care
transitions.
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• Patient outcome measures. This
three-phase project focuses on crosscutting and condition-specific outcome
measures. Specifically, outcome
measures will be endorsed for patients
with Medicare high priority conditions,
such as: Congestive heart failure,
chronic obstructive pulmonary disease,
arthritis, diabetes, depression, and
several types of cancers. There is also a
phase of work dedicated to outcome
measures for children. The conditions
included in each phase are:
Æ Phase I: Cardiovascular diseases,
including acute myocardial infarction,
ischemic heart disease, congestive heart
failure, atrial fibrillation, and stroke/
transient ischemic attacks, metabolic
diseases, including diabetes and chronic
kidney disease; and pulmonary
diseases, including asthma and chronic
obstructive pulmonary disease.
Æ Phase II: Cancer, including breast,
lung, colorectal, and endometrial
cancers; bone/joint diseases, including
hip fracture, osteoporosis, and arthritis;
and infection, including pneumonia.
Æ Phase III: Child health and mental
health. In future years, measures
derived from this phase include a core
measure set for the Children’s Health
Insurance Program Reauthorization Act
of 2009.
• Nursing home measures. This
project focuses on the endorsement of
performance measures for nursing
homes. It will include an updated set of
measures to assess and improve care
provided in nursing homes.
Patient Safety. NQF has a sizable
portfolio of endorsed serious reportable
events, patient safety measures, and safe
practices that are used extensively by
DHHS and states in reporting and
payment programs, and by providers for
improvement purposes. On October 6,
2009, NQF convened the Patient Safety
Advisory Committee to assess current
initiatives and develop a two-year
strategic work plan for the evolution of
the NQF portfolio. This strategic plan,
when completed in fall 2010, will guide
NQF’s safety work in 2011 and 2012.
The initial set of 2009 projects focuses
on known gap areas.
• Serious Reportable Events (SREs).
NQF has long been a pioneer in this
area, dating to its 2002 report Serious
Reportable Events in Healthcare: A
Consensus Report, which listed 27
preventable events leading to death or
serious injury that should be publicly
reported. (The program was updated in
2006, with a 28th event added.) This list
formed the core of the Medicare nonpayment program for healthcareacquired conditions, as well as many
state-based adverse event reporting
initiatives. This project will consider
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expanding the list of serious reportable
events to include events that are
applicable to additional non-hospital
settings, such as nursing homes and
ambulatory care settings. The project
includes convening representatives of
state-based adverse event-reporting
agencies to review the current
environment of adverse event reporting
systems, related issues, and unintended
consequences, as well as to obtain their
input on the next generation of events.
• Patient safety measures. This
project focuses on key safety measures
such as healthcare-associated infections.
As a part of this project, currently
endorsed infection measures will be
updated to reflect updated case
definitions from the Centers for Disease
Control and Prevention. Other focus
areas for patient safety measures will
include condition specific measures and
reviewing applicability of safety
measures to a variety of environments of
care.
• Patient safety public reporting
guidelines. Public reporting of patient
safety performance results can be
challenging, especially for serious
reportable events and low-frequency
safety events. This project aims to
develop a framework and guidelines for
measuring, evaluating, and publicly
reporting patient safety information
across the spectrum for severity and
frequency of events.
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Maintenance of Previously Endorsed
Measures (Task 8)
Healthcare performance measures and
similar consensus standards are useful
for improving quality only as long as the
standards reflect current knowledge and
state-of-the art, high-quality care. The
maintenance of NQF-endorsed measures
is of critical importance because the
science underlying both clinical
practice and safe, effective, and efficient
care delivery evolves over time.
Ongoing maintenance processes also
ensure that measure specifications
reflect updates in coding systems, such
as ICD–10–CM.
Specifically, the currency of the NQF
portfolio refers to four factors:
1. Importance of the Measure Topic.
Does the measure reflect current clinical
science and guidelines? Is there still a
gap between actual and ideal
performance? (Or is the measure
‘‘topped out?’’)
2. Measure Specifications. Do the
specifications reflect current coding and
classification systems? (In addition, as
discussed below, future maintenance
processes will require stewards to
submit e-specifications so measures can
be used with electronic health records.)
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3. Harmonization. There are currently
dozens of measure developers, all of
whom follow different conventions and
practices when specifying measures.
Through its endorsement and
maintenance processes, NQF works
with measure stewards to harmonize
their measures. Harmonization
facilitates the use of measures in sets
(e.g., a composite measure for patients
with diabetes that reflects the outcomes
and clinical process measures for a
patient-focused episode) and makes it
easier to understand and interpret
results. Harmonization also lessens the
burden of implementation.
4. Best in Class. There is much
innovation in the development of
measures. NQF-endorsed measures are
subject to a competitive review every
three years in which they must
demonstrate ‘‘best in class’’ when
compared directly with other candidate
measures.
In 2009, NQF developed a
comprehensive schedule for review of
measures pertaining to the leading
conditions and the National Priorities
Partnership cross-cutting areas. The new
measure maintenance schedule will
provide an annual update of measure
specifications. Measures will undergo a
comprehensive review at least every
three years, including harmonization
and best in class considerations. In
addition to scheduled maintenance, ad
hoc maintenance reviews are conducted
if there are significant changes in the
science base requiring immediate
attention or concerns are raised about
untoward consequences of
measurement.
Promotion of EHRs (Task 9)
It is broadly recognized that EHR
systems can improve the quality of care
delivered to patients. Health
information technology (HIT)-enabled
content and transactions can make
important healthcare information more
readily available to those who need it
when they need it. If implemented with
careful attention to workflow and
content needs, EHR systems will
appreciably improve the safety,
effectiveness, and efficiency of
American healthcare, leading to
widespread and sustainable quality
improvement. Such systems will
support clinical decisions; grant
patients and clinicians access to health
records and improve the accuracy of
those records; seamlessly integrate
clinical and payment functions; and
facilitate the collection, reporting, and
analysis of quality data.
• The ‘‘eMeasure.’’ In 2009, NQF
developed and oversaw standardization
of the Health Quality Measure Format,
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commonly known as the ‘‘eMeasure,’’
representing a health quality 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 a critical
component of the workflow to support
‘‘meaningful use’’ of electronic records
as described by the American Recovery
and Reinvestment Act of 2009. The
eMeasure was successfully balloted by
the technical standards development
organization HL7 at its September 2009
workgroup meeting. The sponsoring
workgroup, Structured Documents,
approved the ballot as a draft standard
for trial use on November 4, 2009. The
measure was successfully tested in the
HITSP Connectathon in January 2010.
• Measure Retooling. In 2009, under
the DHHS contract, NQF undertook
implementation of its previously
completed Quality Data Set (QDS) 5 (see
Exhibit C) by applying the QDS to
measures already endorsed by NQF.
NQF staff created an authoring
environment for the retooling effort to
manage consistency with the QDS and
to make the process as efficient as
possible. That environment is complete
and will be used by measure developers
to retool high-priority measures
requested by CMS.
• QDS Model and Repository. In the
contract’s first year, some work on
standardizing the management of code
lists was performed in the standards
harmonization process in the Healthcare
Information Technology Standards
Panel (HITSP) in summer 2009. The HIT
Standards Committee has now
established a task force on vocabulary,
which began work in January 2010 to
define the governance and infrastructure
rules for vocabulary management.
NQF’s participation in that task force
supports the registry requirements in a
stand.
Exhibit C: About the QDS
The Quality Data Set (QDS),
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 quality measures.
It is a classification system by which
measure developers can offer and refine
definitions. Once fully developed, the
QDS will be a centralized repository of
quality data requirements (such as
concepts, data types, data elements, and
code lists) and data definitions used by
multiple stakeholders to develop,
specify, and use quality measures. The
QDS aims to provide direction to
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measure developers, EHR vendors, and
other stakeholders on how to define
quality terminology without ambiguity.
Although the QDS was developed under
an earlier grant from the Agency for
Healthcare Research and Quality, its
implementation is covered under the
current DHHS contract.ard manner.
• Measure Authoring Tool and
Guidelines. In 2009, NQF identified
requirements for a measure authoring
tool and created a prototype
environment for use in the measure
retooling effort. An NQF tooling/
retooling guide is planned that will
expand on that effort, and a more
detailed authoring tool will be available
for use to create electronic measures in
January 2011.
• Linking Performance Measurement
to Clinical Decision Support. NQF
convened a Clinical Decision Support
Expert Panel, which met on November
11–12, 2009. The panel created a
clinical decision support taxonomy
framework and adapted the QDS data
requirements to support clinical
decision support.
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The Development of a Public Web Site
(Task 11)
NQF in 2009 undertook an effort to
redevelop its own Web site to guarantee
that its proceedings would be fully
transparent to all stakeholders. The Web
site, https://www.qualityforum.org, is
now fully operational and features an
electronic measure submission form to
enhance the Consensus Development
Process and measure maintenance
activities. Specifically, funding from the
DHHS contract in this task was used to:
• Produce a new Web site for
information about NQF’s Consensus
Development Process and its specific
projects, including their status and
opportunities for public and member
input;
• Implement additional Web site
features; and
• Perform ongoing management of
web-based content.
The site was developed and is
operated using a content management
system to support better content
organization and maintenance and
editorial oversight. The implementation
included integration with other NQF
systems and laid a technological
foundation that will enable future
enhancements. Achievements resulting
from this work include:
• A new structure for project
information that clearly presents the
progress of work through NQF’s
Consensus Development Process and
supports and encourages public review
and input;
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• Site personalization for registered
users, including a dashboard in which
users can access information about their
participation in NQF activities;
• An online measure submission form
and process that improves the electronic
collection and dissemination of the
information needed to evaluate
performance measures for potential
endorsement;
• An improved online voting
platform, including the ability for users
to see the status of their organization’s
participation; and
• An online directory of NQFendorsed consensus standards.
(ICD–9) to ICD, Tenth Revision, Clinical
Modification (ICD–10–CM) by 2013. In
this project, NQF is examining the
implications of additional code set
requirements on performance measures
and developing guidance and a
schedule for updating measures by the
2013 coding conversion deadline. In
2009, NQF convened an expert panel to
consider coding issues and how they
affect performance measurement,
including defining and laying out a
process for responding to ‘‘material
changes’’ in measures that may result
from the coding conversion process.
This work is ongoing.
Measurement Development,
Harmonization, and Endorsement (Task
12)
The DHHS contract provides for
measure development and related
activities to fill gap areas. In 2009, NQF
published requests for proposals for
‘‘indefinite need, indefinite quantity’’
contracts to build capacity in case
DHHS decides that performance
measures are needed in any given area.
This capacity was not requested by
DHHS in the first year of the contract.
Other specific projects under this task
included:
• Harmonization. To identify gaps in
appropriate care at the appropriate
junctures, work is needed to adopt
global, harmonized quality measures in
all settings. The opportunity to link
measurement across providers and sites
of care will form the foundation for a
systems-based perspective to healthcare
delivery, the reduction or elimination of
preventable illnesses, and the delivery
of high-quality care. Thus, NQF is
planning to identify the steps needed to
achieve harmonization, including how
to encourage measure developers to
achieve measure harmonization with
measures across sites and providers of
care. This work is ongoing.
• Efficiency and resource use
measures. The current portfolio of NQF
measures contains very limited numbers
of performance measures to assess
efficiency and resource use. In its new
phase of work, NQF has received 18
measures in mammography, appropriate
use of CT scans, and cardiac imaging. A
second phase of work will focus on
measures of episode-based resource use.
• ICD–10. DHHS utilizes various code
sets to classify medical care for
purposes of payment and performance
measurement. The International
Classification of Diseases (ICD) code
set 6 is used to identify diagnoses
(diseases, injuries, and impairments)
and procedures (diagnosing, managing,
treating, preventing). DHHS intends to
convert from the ICD, Ninth Revision
4. 2010 and Beyond: A Look Ahead
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The decade since IOM published To
Err is Human has seen the maturation of
the modern-day healthcare quality
improvement movement in the United
States. It is no longer accepted as a
matter of faith that the United States
boasts the ‘‘best healthcare system in the
world.’’ Today, we know that despite the
heroic effort of millions of dedicated
individuals, healthcare quality is
deficient in many areas. Further, we
know that healthcare quality is
measurable, and that quality
deficiencies must be measured—with
the results of these measurements
publicly reported—if we hope to correct
them. This recognition, while sobering,
has led to a national commitment to
improve the quality of healthcare for all
Americans. Following this commitment,
the recognition has led to the
construction of a national infrastructure
for quality improvement—including the
formulation of national priorities, the
use of agreed-upon performance
measures to gauge quality, and an EHR
system to collect and disseminate
performance data.
As the quality movement has
matured, so too has the National Quality
Forum. When the President’s Advisory
Commission on Consumer Protection
and Quality in the Health Care Industry
proposed the creation of a forum that
would convene disparate stakeholders
to formulate a national strategy for
healthcare quality, the idea seemed
novel. Today, NQF is itself a firmly
entrenched stakeholder, advocating for
healthcare quality improvement while
serving no interest other than that of the
public at large.
NQF’s work today supports key DHHS
work outlined in the American
Recovery and Reinvestment Act of 2009
in three important ways:
• Supporting the HIT provisions by
ensuring that EHRs have the necessary
capabilities to foster performance
measurement and public reporting;
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• Focusing performance
improvement activities on reducing
healthcare-associated infections and
enhancing chronic disease outcomes;
and
• Identifying key gaps in the evidence
base to sustain the Recovery Act’s
comparative effectiveness research
goals.
NQF remains firmly committed to a
broad, quality-focused transformation of
the healthcare system, including
supporting goals in quality, access, and
affordability that may be achieved
through national health reform
legislation.
The focus of the American quality
improvement endeavor has moved
beyond measures of process to include
measures of outcomes that matter most
to patients. In response to soaring
healthcare costs, efforts are now
underway to develop and endorse
efficiency measures that can be used to
remove waste and unnecessary services
from the healthcare system. This shift is
fraught with challenges as the
healthcare industry seeks to find and
agree upon measures that are important,
scientifically acceptable, usable, and
feasible—and is subject to controversy
because results of these measures will
be used in payment and public
reporting programs.
The quality infrastructure we are
building today will be important for
decades to come. It is a fundamental
building block for transforming the
American healthcare system to provide
patient-centered care that is safe,
effective, and affordable.
The National Quality Forum,
Washington, DC, March 1, 2010.
5. Appendices and Notes
emcdonald on DSK2BSOYB1PROD with NOTICES
Appendix A: About National Quality
Forum
The National Quality Forum is a nonprofit
organization that aims to improve the quality
of healthcare for all Americans through
fulfillment of its three-part mission:
• Setting national priorities and goals for
performance improvement;
• Endorsing national consensus standards
for measuring and publicly reporting on
performance; and
• Promoting the attainment of national
goals through education and outreach
programs.
NQF was created in 1999 at the
recommendation of the President’s Advisory
Commission on Consumer Protection and
Quality in the Health Care Industry.7 Today,
it is uniquely positioned to serve as a
national coordinating and standard-setting
center for performance measures. The NQF
Board of Directors includes public- and
private-sector representatives, with a simple
majority of its at-large seats held by
consumers and those who purchase services
on their behalf. (See Appendix B.) It works
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collaboratively with multiple quality
alliances, and has unmatched experience in
evaluating and endorsing measures of
healthcare performance, many of which are
in widespread use. From its inception, NQF
sought to convene disparate stakeholders to
work toward the common goal of improving
healthcare quality by advancing performance
measurement and public reporting. NQF
member organizations are organized into
eight member councils—consumers;
purchasers; healthcare professionals; health
plans; provider organizations; public/
community health agencies; quality
measurement, research and quality
improvement organizations; and suppliers
and industry.
Adhering to the National Technology
Transfer and Advancement Act of 1995 (Pub.
L. 104–113) 8 and the Office of Management
and Budget’s definition of consensus,9 NQF
endorses performance measures, best
practices, serious reportable events,
measurement frameworks, and reporting
guidelines through its formal Consensus
Development Process,10 which is designed to
call for input and carefully consider the
interests of stakeholder groups from across
the healthcare industry. The strict adherence
to this Consensus Development Process
qualifies NQF as a voluntary consensus
standards-setting organization, granting its
endorsed measures and best practices special
legal standing. NQF’s work can be divided
into three broad categories:
1. National Priorities and Goals. In 2008,
NQF embarked on the nation’s largest effort
to determine national priorities for healthcare
quality improvement. NQF convened the
National Priorities Partnership (NPP), a
diverse group of 32 major national
organizations representing those who receive,
pay for, deliver, and evaluate healthcare. (See
Appendix D.) The NPP, co-chaired by Donald
M. Berwick, MD, MPP, president and CEO of
the Institute for Healthcare Improvement,
and Margaret E. O’Kane, president of the
National Committee for Quality Assurance,
sought to set in motion a national movement
to deliver transformative improvements to
the nation’s health and healthcare system. In
2008, the NPP released a landmark action
agenda, with six priorities to transform
healthcare during a time of severe economic
strain by better investing resources to
fundamentally improve patient care and
outcomes. These priorities and the specific,
measurable actions springing from them
guide much of NQF’s ongoing work.
2. Endorsement of Consensus Standards.
The careful evaluation and endorsement of
consensus standards is central to NQF’s
ongoing mission to improve the quality of
American healthcare. Using its rigorous
Consensus Development Process, NQF fosters
consensus among a wide variety of
stakeholders around specific standards that
can be used to measure and publicly report
healthcare quality. NQF endorses several
different kinds of consensus standards, each
of which can be used to assess different
aspects of healthcare quality: performance
measures, practices, frameworks, and
reporting guidelines. To date, NQF has
endorsed more than 550 consensus
standards.
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Æ Performance Measures. Measures
gauging the performance of healthcare
endorsed by NQF are used for measuring and
publicly reporting on the performance of
different aspects of the healthcare system and
are widely viewed as the ‘‘gold standard’’ for
the measurement of healthcare quality. One
early model for the implementation of NQF
endorsed performance measures was
National Voluntary Consensus Standards for
Hospital Care: An Initial Performance
Measure Set.11 This report contained 39
performance measures gauging the quality of
care delivered in hospitals. It was endorsed
through NQF’s Consensus Development
Process. These hospital measures took on
additional importance when 10 of them
became the ‘‘starter set’’ of measures
employed by the Hospital Quality Alliance 12
and CMS’s Hospital Compare 13 to encourage
public reporting of hospital performance
measures.
Æ Patient Safety. NQF has an established
track record of national leadership regarding
patient safety. Two of its very early projects
launched NQF’s work in this area. The first
was Serious Reportable Events in Healthcare:
A Consensus Report,14 in which NQF named
27 events leading to death or serious injury
that should not occur in any healthcare
setting, but unfortunately do, and should be
publicly reported when they do occur. These
events and their NQF revisions became the
cornerstone of many state-based adverse
event-reporting initiatives and of CMS’s
policies regarding payment for healthcareacquired conditions. The second was Safe
Practices for Better Healthcare: A Consensus
Report,15 a set of 30 practices that, if
universally applied in all clinical care
settings, would substantially reduce the risk
of error and harm for patients. These
practices have become the standard by which
many healthcare organizations measure their
patient safety goals and strategies. Both of
these reports have been revised twice since
initial publication.
3. Education and Outreach. As part of its
ongoing commitment to the advancement of
healthcare quality, NQF produces a variety of
publications, such as issue briefs; conducts
educational outreach sessions such as
webinars; sponsors an annual conference that
brings together healthcare and community
leaders to develop national solutions to
quality concerns; convenes healthcare
executives annually for an invitational
Leadership Colloquium; and sponsors two
annual recognition programs, the National
Quality Healthcare Award and the John M.
Eisenberg Patient Safety and Quality Awards,
highlighting the achievements of
professionals and providers.
In 2008, Congress provided a clear
mandate and a stable funding stream to
address gaps and weaknesses that stood
between today’s realities and the creation of
a coherent national system for establishing
performance measures. High-quality
standardized performance measures are a
public need as well as a public good that
benefits all stakeholders. In 2009, NQF was
awarded a contract with DHHS under the
Medicare Improvements for Patients and
Providers Act of 2008 (Pub. L. 110–275). The
contract provided $10 million for year after
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award, with the option for three $10 million
annual renewals. This contract granted NQF
a stable source of core funding to pursue this
important work in a coordinated, strategic
manner.
Today, NQF is one of the largest
consensus-based organizations in healthcare
in the United States. Its more than 400
organizational members represent every
aspect of the U.S. healthcare system. It has
evolved into a truly broad, fully
representational organization supporting the
nation’s quest for a ‘‘true north’’ for
healthcare quality. Its strength lies in the
active participation of its broad, diverse
membership. NQF’s unique structure enables
private- and public-sector stakeholders to
work together to craft and implement crosscutting solutions to drive continuous quality
improvement in the American healthcare
system. NQF remains committed to
maintaining a constant drumbeat for
healthcare quality.
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Appendix B: NQF Board of Directors
William L. Roper, MD, MPH (Chair), Dean,
School of Medicine, Vice Chancellor for
Medical Affairs and CEO, UNC Health Care
System, University of North Carolina at
Chapel Hill.
John C. Rother, JD (Vice Chair), Executive
Vice President for Policy and Strategy,
AARP.
Gerald M. Shea (Secretary), Assistant to the
President for External Affairs, AFL–CIO.
Richard J. Baron, MD, President and CEO,
Greenhouse Internists.
Bruce Bagley, MD, Medical Director for
Quality Improvement, American Academy
of Family Physicians.
Lawrence M. Becker, Director, HR Strategic
Partnerships, Xerox Corporation.
JudyAnn Bigby, MD, Secretary of Health &
Human Services, Commonwealth of
Massachusetts.
Carolyn M. Clancy, MD, Director, Agency for
Healthcare Research and Quality.
Francis S. Collins, MD, PhD, Director,
National Institutes of Health.
Janet Corrigan, PhD, MBA, President and
CEO, National Quality Forum.
Maureen Corry, MPH, Executive Director,
Childbirth Connection.
Helen Darling, MA, President, National
Business Group on Health.
Charlene Frizzera, Acting Administrator,
Centers for Medicare & Medicaid Services.
Robert Galvin, MD, Director of Global
Healthcare, General Electric.
Wade Henderson, Esq., President and CEO,
Leadership Conference on Civil Rights.
Karen Ignagni, MBA, President & CEO,
America’s Health Insurance Plans.
Chris Jennings, President, Jennings Policy
Strategies, Inc.
Charles N. ‘‘Chip’’ Kahn III, MPH, President,
Federation of American Hospitals.
Peter V. Lee, JD, Executive Director of
National Health Policy, Pacific Business
Group on Health.
Mark B. McClellan, MD, PhD, Director,
Engelberg Center for Healthcare Reform,
Senior Fellow for Economic Studies, and
Leonard D. Schaeffer Chair in Health
Policy Studies, The Brookings Institution.
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Sheri S. McCoy, MBA, Worldwide Chairman
of the Pharmaceuticals Group, Johnson &
Johnson.
Harold D. Miller, President and CEO,
Network for Regional Healthcare
Improvement.
Mary Naylor, PhD, RN, Marian S. Ware
Professor in Gerontology at the University
of Pennsylvania School of Nursing, and
Director of NewCourtland Center for
Transitions and Health.
Debra L. Ness, President, National
Partnership for Women and Families.
Nancy H. Nielsen, MD, PhD, Immediate Past
President, American Medical Association.
Samuel R. Nussbaum, MD, Executive Vice
President & Chief Medical Officer,
WellPoint, Inc.
J. Marc Overhage, MD, PhD, Director of
Medical Informatics, Regenstreif Institute.
Bernard M. Rosof, MD, Chair, Board of
Trustees, Huntington Hospital.
Joseph R. Swedish, President and CEO,
Trinity Health.
Curt Selquist (Chair, Leadership Network, ex
officio), Johnson & Johnson Healthcare
Systems, Inc. (retired).
John Tooker, MD, MBA, FACP, Executive
Vice President and CEO, American College
of Physicians.
Richard J. Umbdenstock, MS, FACHE,
President and CEO, American Hospital
Association.
Andrew Webber, President and CEO,
National Business Coalition on Health.
Appendix C: Key NQF Staff Working
Under the DHHS
Janet M. Corrigan, PhD, MBA, President and
Chief Executive Officer.
Helen Burstin, MD, MPH, Senior Vice
President for Performance Measures.
Floyd Eisenberg, MD, MPH, FACP, Senior
Vice President for Health Information
Technology.
Laura Miller, MPA, Senior Vice President
and Chief Operating Officer.
Thomas Valuck, MD, MHSA, JD, Senior Vice
President for Strategic Partnerships.
Karen Adams, PhD, Vice President of
National Priorities.
Alicia C. Aebersold, Vice President of
Communications.
Marybeth A. Farquhar, PhD, MSN, RN, Vice
President for Performance Measures.
Lawrence D. Gorban, MA, Vice President of
Operations.
Bruce Pelleu, CPA, Chief Financial Officer.
Peter B. Angood, MD, FRCS(C), FACS,
FCCM, Senior Advisor, Patient Safety.
Alexis Forman, MPH, Program Director,
Performance Measures.
Margaret Kay, Director of Publications.
Lindsay Lang, MHSA, RN, Program Director,
Performance Measures.
Nicole Williams McElveen, MPH, Program
Director, Performance Measures.
Karen Pace, PhD, RN, Senior Program
Director.
Ashlie Wilbon, MPH, RN, Program Director,
Performance Measures.
Appendix D: National Priorities
Partnership
AAR
AFL–CIO
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Agency for Healthcare Research and Quality
Aligning Forces for Quality
Alliance for Pediatric Quality
America’s Health Insurance Plans
American Board of Medical Specialties
American Health Care Association
American Nurses Association
AQA
Centers for Disease Control and Prevention
Centers for Medicare & Medicaid Services
Certification Commission for Health
Information Technology
Consumers Union
Hospital Quality Alliance
Institute for Healthcare Improvement
Institute of Medicine
Johnson & Johnson
Leapfrog Group
National Association of Community Health
Centers
National Business Group on Health
National Committee for Quality Assurance
National Governors Association
National Institutes of Health
National Partnership for Women & Families
National Quality Forum
Pacific Business Group on Health
Physician Consortium for Performance
Improvement convened by the American
Medical Association
PQA
Quality Alliance Steering Committee
The Joint Commission
U.S. Chamber of Commerce
Notes
1 Kohn LT, Corrigan JM, Donaldson MS,
eds. To Err is Human: Building a Safer
Health System. Committee on Quality of
Health Care in America, Institute of
Medicine. Washington, DC: National
Academy Press; 2000.
2 Medicare Improvements for Patients and
Providers Act (Pub. L. 110–275). Available
online at https://frwebgate.access.gpo.gov/cgibin/getdoc.cgi?dbname=110_cong_bills&
docid=f:h6331enr.txt.pdf. Last accessed
December 2009.
3 National Priorities Partnership (NPP).
Available online at https://www.
nationalprioritiespartnership.org/. Last
accessed December 2009.
4 NPP. National Priorities & Goals: Aligning
Our Efforts to Transform America’s
Healthcare. Washington, DC: National
Quality Forum (NQF); 2008.
5 NQF. Policy Brief: HITEP II. Issue Brief
No. 17; October 2009. Washington, DC: NQF;
2009.
6 International Classification of Diseases.
Available at https://www.who.int/
classifications/icd/en/. Last accessed January
2010.
7 President’s Advisory Commission on
Consumer Protection and Quality in the
Health Care Industry. Quality First: Better
Health Care for All Americans. March 12,
1998. Available online at https://www.
hcqualitycommission.gov/final/. Last
accessed December 2009.
8 National Technology Transfer and
Advancement Act of 1998 (Pub. L. 104–113).
Available online at https://ts.nist.gov/
standards/information/113.cfm. Last
accessed December 2009.
9 U.S. Office of Management and Budget.
Circular No. A–119, February 10, 1998.
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Federal Register / Vol. 75, No. 204 / Friday, October 22, 2010 / Notices
emcdonald on DSK2BSOYB1PROD with NOTICES
Available online at https://www.whitehouse.
gov/omb/rewrite/circulars/a119/a119.html.
Last accessed December 2009.
10 NQF. NQF Consensus Development
Process, v. 1.8. Available online at https://
www.qualityforum.org/Measuring_
Performance/Consensus_Development_
Process.aspx. Last accessed December 2009.
11 NQF. National Voluntary Consensus
Standards for Hospital Care: An Initial
Performance Measure Set. Washington, DC:
NQF; 2003.
12 Hospital Quality Alliance: Improving
Care Through Information. Available online
at https://www.hospitalqualityalliance.org/.
Last accessed December 2009.
13 Hospital Quality Compare—A quality
tool provided by Medicare. Available online
at www.HospitalCompare.hhs.gov. Last
accessed December 2009.
14 NQF. Serious Reportable Events in
Healthcare: A Consensus Report.
Washington, DC: NQF; 2002.
15 NQF. Safe Practices for Better
Healthcare: A Consensus Report.
Washington, DC: NQF; 2003.
IV. Secretarial Comments on the
Annual Report to Congress
The Secretary is pleased with the
scope and vision of NQF’s March 2010
annual report. An internal
multidisciplinary cross-component HHS
team is working collaboratively with
NQF to ensure a clear multi-year vision
to ensure the most efficient and effective
utilization of the HHS contract. The
contract with this consensus-based
entity, NQF, provides a unique
opportunity to further enhance HHS’
efforts to foster a collaborative, multistakeholder approach to increase the
availability of national voluntary
consensus standards for quality and
efficiency measures to ensure broad
transparency in achieving value in
health care delivery.
Over the past year NQF began work
on several tasks outlined in the
Statement of Work, including:
Development of a national strategy for
performance measurement and
prioritization of measures for
development and endorsement; an
evaluation of NQF’s consensus
development process; several measure
endorsement projects focused on
measure gap areas such as outcomes
measures and patient safety measures;
maintenance of currently NQF-endorsed
measures; promotion of Electronic
Health Records through such activities
as the development of the ‘‘E-measure’’
and the retooling of a subset of existing
NQF-endorsed measures into E-measure
format; development of a public website
to make available current NQF
activities; endorsement of efficiency and
resource use measures. The Secretary is
pleased with the progress and
timeliness of the work outlined in the
Annual Report.
VerDate Mar<15>2010
17:43 Oct 21, 2010
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V. Future Steps
The consensus based contract with
NQF is a four year contract. During the
first full performance year of the
contract, NQF completed deliverables
for each task. HHS will continue to task
NQF with single year and multi-year
projects.
Formulation of National Strategy and
Priorities for Health Care Performance
Measurement
During March 2009 to February 2010,
NQF created a framework for
measurement prioritization by
conducting an environmental scan of, at
a minimum, the 20 patient conditions
that account for over 95% of costs to the
Medicare program. NQF established a
steering committee to oversee the
prioritization process and to consider
additional measurement streams (e.g.
population health, child health, Health
IT) in its prioritization process.
Consensus Development Process for
Measure Endorsement
During March 2009 to February 2010,
NQF established steering committees to
consider endorsement of outcomes
measures in 3 phases. The first 2 phases
will endorse outcomes measures for
patients with Medicare high priority
conditions. The third phase will
endorse outcomes measures for mental
health and for children. Future steps
also include the endorsement of
measures for patients in Nursing Homes
as well as Patient Safety measures.
Maintenance of Consensus Endorsed
Measures
During March 2009 to February 2010,
NQF maintained endorsed measures
relevant to HHS-wide programs and will
be maintaining consensus-based
endorsed measures as developed under
the priority process.
Promotion of Electronic Health Records
During March 2009 to February 2010,
NQF supported the promotion of
electronic health records as part of HHSwide efforts. NQF developed the Health
Quality Measure Format (HQMF, or ‘‘Emeasure’’), began the retooling process
to convert a sub-set of currently
endorsed measures into E–Measure
format, and supported the HIT
Standards Panel in developing code lists
and vocabulary standards for the
transition to performance measurement
through Electronic Health Records.
Future steps include the retooling of the
remaining subset of currently endorsed
measures, the development of a measure
authoring tool for creating E-measures,
and to support clinical decision support
systems for measuring and reporting
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65349
performance. NQF will also support the
selection of performance measures for
the Meaningful Use of electronic health
records.
Focused Measure Development,
Harmonization, and Endorsement
Efforts To Fill Critical Gaps in
Performance Measurement
During March 2009 to February 2010,
NQF supported a variety of performance
measurement efforts including, but not
limited to, the areas of efficiency,
harmonization, outcomes, patient safety,
care coordination, ICD–10, palliative
care, and nursing home quality metrics.
The public is encouraged to give
input through the NQF process and will
be able to track the progress on work
related to this contract on the NQF Web
site located at: https://
www.qualityforum.org/projects/
ongoing/hhs/.
VI. 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: October 15, 2010.
Kathleen Sebelius,
Secretary, Department of Health and Human
Services.
[FR Doc. 2010–26795 Filed 10–21–10; 8:45 am]
BILLING CODE 4150–05–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Decision To Evaluate a Petition To
Designate a Class of Employees From
BWX Technologies Inc., Lynchburg,
VA, To Be Included in the Special
Exposure Cohort
National Institute for
Occupational Safety and Health
(NIOSH), Department of Health and
Human Services (HHS).
ACTION: Notice.
AGENCY:
HHS gives notice as required
by 42 CFR 83.12(e) of a decision to
evaluate a petition to designate a class
of employees from BWX Technologies,
Inc., Lynchburg, Virginia, to be included
in the Special Exposure Cohort under
the Energy Employees Occupational
Illness Compensation Program Act of
2000. The initial proposed definition for
the class being evaluated, subject to
revision as warranted by the evaluation,
is as follows:
SUMMARY:
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Agencies
[Federal Register Volume 75, Number 204 (Friday, October 22, 2010)]
[Notices]
[Pages 65340-65349]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2010-26795]
-----------------------------------------------------------------------
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.
-----------------------------------------------------------------------
SUMMARY: This notice acknowledges 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
regarding performance measurement as mandated by section 183 of the
Medicare Improvements for Patients and Providers Act of 2008 (MIPPA).
The statute requires HHS to publish not later than six months after
receiving the annual report to Congress in the Federal Register
together with any Secretarial comments.
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. Congress
mandated the Secretary of the Department of Health and Human Services
(HHS) to contract with a consensus-based entity regarding performance
measurement to support HHS' efforts to achieve value as a purchaser of
high-quality, patient-centered, and financially sustainable health
care. Section 183 of the Medicare Improvements for Patients and
Providers Act of 2008 (MIPPA) added section 1890 to the Social Security
Act (the Act). The statute mandates that the contract shall be
competitively awarded for a period 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' contract activities, if applicable.
The HHS four-year contract with NQF includes the following major
tasks:
Formulation of National Strategy and Priorities for Health Care
Performance
[[Page 65341]]
Measurement--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 decisions; 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--At the request and
direction of HHS, 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 website to provide access to project documents and
processes. The HHS contract work is found at: https://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 task; 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, as created by section 183 of MIPPA, 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, the first
annual 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 Secretary of HHS the
second annual report. This notice complies with the statutorily
required Secretarial review and publication of the second annual report
covering the period of performance of March 1, 2009 through February
28, 2010.
II. March 2010--NQF Report to Congress and HHS Secretary
Submitted in March 2010, the second annual report to Congress and
the Secretary spans the period of March 1, 2009 through February 28,
2010.
A copy of NQF's submission of the March 2010 annual report to
Congress and the Secretary of HHS can be found at: https://www.qualityforum.org/projects/ongoing/hhs/.
The 2010 NQF annual report is reproduced in section III of this
notice.
III. NQF March 2010 Annual Report
Strengthening the National Quality Infrastructure National Quality
Forum Accomplishments Under Contract HHSM-500-209-00010C
Report to the Congress and the Secretary of the U.S. Department of
Health and Human Services, Covering the period of March 1, 2009, to
February 28, 2010, Pursuant to PL 110-275 and Contract HHSM-
500-209-00010C
Table of Contents
A Message From the Leadership of the National Quality Forum
Executive Summary
About the Contract
Work Performed by the National Quality Forum Under the DHHS Contract
in 2009
2010 and Beyond: A Look Ahead
Appendices and Notes
Appendix A: About NQF
Appendix B: NQF Board of Directors
Appendix C: NQF Key Staff
Appendix D: National Priorities Partnership
Notes
The mission of the National Quality Forum is to improve the quality
of American healthcare by setting national priorities and goals for
performance improvement, endorsing national consensus standards for
measuring and publicly reporting on performance, and promoting the
attainment of national goals through education and outreach programs.
A Message From the Leadership of the National Quality Forum
Ten years ago, the Institute of Medicine (IOM) exposed the U.S.
healthcare system's numerous quality and patient safety deficiencies
with the publication of its landmark report, To Err is Human.\1\ In the
decade since, numerous local, regional, and national quality
improvement initiatives, including but not limited to programs
supported by the federal and state governments, have sought to correct
these deficiencies. Many of these activities have borne fruit. Some can
definitively be credited with saving American lives.
Despite these successes, and despite the dedicated effort of
millions of well-trained, committed, and compassionate healthcare
workers, the quality of healthcare in the United States still is not
nearly as good as it could or should be. Thousands of Americans die
every year, and millions more are injured, as a result of medical
error. Processes of care vary widely by region, state, and provider,
with no apparent benefit to patients. Healthcare in the United States
is plagued by inequities based on race, ethnicity, gender, and other
factors.
[[Page 65342]]
Costs--including costs to taxpayers--have skyrocketed. Millions of
Americans are denied access to care because they lack sufficient
insurance.
As the decade progressed, it became clear that the nation's
numerous quality initiatives, successful though many may have been,
were no substitute for a coordinated national strategy to
systematically improve the quality of healthcare in the United States.
To help formulate such a strategy, Congress in 2008 passed the Medicare
Improvements for Patients and Providers Act (Pub. L. 110-275).\2\ One
goal of the legislation is to establish a portfolio of quality and
efficiency measures that will allow the federal government to see more
clearly how and whether public healthcare spending is achieving the
best results for Americans. 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 (DHHS) ``to contract with a
consensus-based entity, such as the National Quality Forum.'' This
report summarizes the work performed under this contract between March
1, 2009, and February 28, 2010, the first full year that the DHHS
contract has been in place.
As we review the work performed over the past year, it becomes
apparent that 2009 was a year of building infrastructure to support
healthcare quality. Much like physical infrastructure, the nation's
healthcare quality infrastructure must be constructed with precise
attention to detail, and then maintained so that it meets the expanding
needs of those it serves. Priorities and goals must be identified to
focus improvement efforts on areas that will yield the greatest gains
in terms of improved health and healthcare; and performance measures
must be developed, endorsed, and implemented to gauge delivery system
progress and reveal opportunities for improvement.
Many of the activities NQF has performed under the DHHS contract
are in midstream and extend beyond a single year's worth of work.
Nevertheless, we have completed significant work in several areas,
including:
The development of a prioritized set of conditions for
quality improvement;
The endorsement of performance measures in critical gap
areas; and
The establishment of common protocols and standardized
formats for e-measure specification and the creation of an electronic
measure authoring environment to enable retooling of performance
measures for the assessment of ``meaningful use'' of health information
technology (HIT).
We are grateful to Congress and DHHS for supporting NQF's work in
nurturing the quality enterprise in the United States; to the more than
400 institutional members of NQF who have sustained the organization
and, in doing so, have helped build the healthcare quality improvement
movement; and to NQF's expert panel volunteers and staff, whose
tireless efforts on behalf of American patients contribute to a
healthcare system that is becoming, as the IOM envisioned, safe,
timely, effective, efficient, equitable, and patient centered.
During the last year, we built a stronger foundation for healthcare
performance improvement in the United States. We are confident that in
2010 and beyond, Americans will reap the benefits of our healthcare
quality infrastructure.
1. Executive Summary
The National Quality Forum (NQF) was created in 1999 to develop and
implement a national strategy for healthcare quality improvement. It
has grown into an influential consensus-based organization in
healthcare in the United States, supported by more than 400
organizational members and boasting a unique structure that enables
private and public sector stakeholders to collaborate on cross-cutting
solutions to drive continuous performance improvement. NQF's core work
includes the establishment of national priorities and the endorsement
of performance measures. NQF follows a formal Consensus Development
Process recognized under the National Technology Transfer and
Advancement Act of 1995 (Pub. L. 104-113), which grants its endorsed
measures and best practices special legal standing as national
voluntary consensus standards.
Section 183 of the Medicare Improvements for Patients and Providers
Act (Pub. L. 110-275) of 2008 calls for the Department of Health and
Human Services (DHHS) ``to contract with a consensus-based entity, such
as the National Quality Forum'' (NQF) for the purpose of pursuing
certain activities relating to healthcare performance measurement. On
January 14, 2009, the National Quality Forum was awarded a contract
under this Section. The contract provided up to $10 million for the
first year after award with the option for three $10 million annual
renewals. Among other assignments, the contract called for NQF to:
Develop a prioritized list of conditions that impose heavy
health burden on beneficiaries and account for significant costs;
Identify and endorse measures that can be used by various
stakeholders to assess and improve the care provided to beneficiaries
with these conditions, and the performance of providers in various
healthcare settings; and
Promote the use of electronic health records (EHRs) for
performance measurement, reporting, and improvement.
This report summarizes the work performed under this contract
between March 1, 2009, and February 28, 2010, the first full year that
the DHHS contract has been in place.
Many of the activities NQF has performed under the DHHS contract
are in midstream and extend beyond a single year's worth of work. Under
the DHHS contract, NQF has achieved significant accomplishments in the
following areas:
Developed a framework, composed of the 20 priority
conditions for Medicare and the six cross-cutting priority areas
identified by the NQF-convened National Priorities Partnership, for
focusing performance measurement, public reporting, and improvement
efforts;
Conducted an environmental scan of existing performance
measures and measures under development, and began constructing a
prioritized agenda for measure development and endorsement;
Initiated endorsement projects to expand the portfolio of
NQF-endorsed[supreg] measures in key gap areas: Patient outcomes,
efficiency, patient safety, and nursing home care;
Enhanced processes for ongoing ``measure maintenance'' to
ensure that the more than 550 measures that NQF already has endorsed
are continuously updated to reflect changes in the evidence base as it
evolves and undergo comprehensive assessment on a three-year cycle to
maintain ``best in class'' standing;
Contracted with an applied research firm to conduct an
independent evaluation of its Consensus Development Process;
Began work on a two-year plan for the evolution of NQF's
portfolio of endorsed patient safety measures, ``safe practices,'' and
serious reportable events;
Undertook an environmental scan to review the state of
reporting with respect to patient safety events and serious reportable
events at the federal and state level;
[[Page 65343]]
Completed an evaluation of the types of data that must be
captured in electronic health records (EHRs) to support measurement and
improvement on the more than 550 NQF-endorsed performance measures;
Developed a standardized format (i.e., the Health Quality
Measure Format) for representing a health quality measure in a machine-
readable electronic format, which has now been approved by HL7 for use
in EHRs; and
Produced an enhanced Web site, featuring an online
performance measure submission form, an improved online platform for
public comment, and an online directory of NQF-endorsed consensus
standards.
Much like physical infrastructure, the nation's Healthcare quality
infrastructure must be constructed with precise attention to detail,
and then maintained so that it meets the expanding needs of those it
serves. In 2009, under the DHHS contract, NQF took great strides in
building and supporting that infrastructure. In 2010 and beyond, the
United States will reap significant benefits from investments in this
quality infrastructure, which is critical to support expanded public
reporting and payment reform and foster continuous quality improvement
in American healthcare.
2. 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. Section 183 of the Act, among other things,
directs the Secretary of DHHS 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-500-209-
00010C, under Section 183 of the Medicare Improvements for Patients and
Providers Act. The DHHS contract is administered by the Office of the
Assistant Secretary for Planning and Evaluation (ASPE), which provides
strategic leadership and technical insight for the contract, and by the
Centers for Medicare & Medicaid Services (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 called for NQF to:
Develop a prioritized list of conditions that impose heavy
health burden on beneficiaries and account for significant costs;
Identify and endorse measures that can be used by various
stakeholders 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.
While the work conducted under the contract is intended
specifically to benefit all those served by DHHS 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 and recent accomplishments in three areas:
Setting 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.
Endorsing performance measures. NQF has endorsed more than
500 performance measures and best practices under its formal Consensus
Development Process, granting those measures and practices special
legal standing as voluntary consensus standards.
Facilitating the development of EHRs to support
measurement and improvement. NQF has worked to identify the types of
information that need to be included in an EHR to enable reporting on
quality metrics.
Under the contract, DHHS 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 be attributable to providers where possible. A
premium must be placed on developing measures in key areas that will
have the greatest impact in improving quality and value, rather than
focusing on developing a large number of measures that may be easiest
to produce, such as process measures.''
The contract is divided into 12 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 six 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 the endorsement of healthcare quality measures.
Task 7 includes an evaluation of NQF's Consensus Development Process
and the conduct of consensus 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. Task 12 is divided into three subtasks:
Efficiency, harmonization, and ICD-10.
Details of work performed under the DHHS contract in each of these
tasks are found in Section 3 of this report.
3. Work Performed by the National Quality Forum Under the DHHS Contract
in 2009
This section describes details of work performed under each task
according to the DHHS contract in the past year.
National Strategy and Priorities (Task 6)
A two-dimensional framework--consisting of leading conditions and
cross-cutting areas--has been developed to focus performance
measurement and improvement on high-leverage areas having the greatest
potential to improve health and healthcare. Starting with the Medicare
20 priority conditions, which collectively account for 95 percent of
Medicare expenditures (see Exhibit A), an expert panel is working to
prioritize these conditions based on cost, prevalence, improvability,
variability, and disparities. The second part of the strategy builds on
work previously performed by the National Priorities Partnership,\3\ 32
major national healthcare stakeholder organizations (see Appendix D)
convened by NQF, which identified six crosscutting priority areas that
affect many conditions: Patient and family engagement, population
health, safety, care coordination, palliative and end-of-life care, and
overuse.\4\ To identify gaps, currently available performance measures
have been mapped to this framework.
To further inform the process of setting an agenda for measure
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development and endorsement, NQF is convening experts and gathering
information to identify specific types of measures needed to support
Medicare payment and public reporting programs, ``meaningful use'' of
HIT, and other applications. This work is scheduled for completion in
the third quarter of 2010.
Exhibit A: Medicare 20 Priority Conditions
To assist in carrying out its responsibilities, in 2009 NQF issued
a firm, fixed-price contract for a qualified contractor to perform a
systematic review and synthesis of evidence relating to 20 high-
priority conditions identified by the Centers for Medicare & Medicaid
Services. Patients with these conditions account for more than 95
percent of Medicare's costs. The 20 conditions (not in any order of
priority) are:
Acute myocardial infarction
Alzheimer's disease and related disorders
Atrial fibrillation
Breast cancer
Cataract
Congestive heart failure
Chronic kidney disease
Colorectal cancer
Chronic obstructive pulmonary disorder
Diabetes
Endometrial cancer
Glaucoma
Hip/pelvic fracture
Ischemic heart disease
Lung cancer
Major depression
Osteoporosis
Prostate cancer
Rheumatoid arthritis and osteoarthritis
Stroke/transient ischemic attack
Consensus Development Process for Measure Endorsement (Task 7)
The stakeholder-based endorsement of performance measures via a
formal Consensus Development Process (CDP) has long been NQF's ``stock
in trade.'' This task involves both a formal evaluation of the
endorsement process and the conduct of a set of endorsement projects
focused on known measure gap areas.
Evaluation of the Consensus Development Process. NQF follows a
nine-step process (Exhibit B) to evaluate and endorse consensus
standards, including performance measures, serious reportable events,
best practices, measurement frameworks, and reporting guidelines. The
process is designed to ensure that performance measures endorsed by NQF
satisfy certain criteria (i.e., importance, scientific acceptability,
usability, and feasibility) and represent the ``best in class.'' The
process is transparent and provides for extensive input from all
stakeholders. Over the past 10 years, the steps that form NQF's
Consensus Development Process and its implementation have evolved to
ensure that evaluation of Candidate Consensus Standards continues to
follow best practices in performance measurement and standards setting.
In 2009, under the DHHS contract, NQF contracted with Mathematica
Policy Research Inc. to conduct an independent evaluation of the
Consensus Development Process. This evaluation also includes gathering
information on similar processes of other standard-setting bodies,
which is expected to be useful in further refining NQF's endorsement
process. This report is scheduled for completion in October 2010, with
the proposed enhancements to the Consensus Development Process
scheduled to be considered in January 2011.
Exhibit B: NQF Consensus Development Process (Version 1.8)
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 Decision.
8. Board Ratification.
9. Appeals.
Endorsement Projects. The current DHHS contract facilitates a
coordinated, strategic approach to endorsing performance measures.
As noted above, efforts are underway to develop a comprehensive
agenda for measure development and endorsement, which will guide future
endorsement work. During this first year of the DHHS contract, the
schedule of endorsement projects was determined though a collaborative
process involving representatives from the various DHHS departments and
NQF, targeting well-known gap areas. On average, it takes less than one
year to complete the nine-step Consensus Development Process.
Endorsement projects fall into two broad categories: Quality and
efficiency, and patient safety.
Quality and Efficiency. Many projects in this area focus on
measures of patient outcomes and efficiency, thus laying the groundwork
for assessing the ``value'' received from healthcare services.
Considerable attention also is paid to settings outside the hospital
and to care transitions.
Patient outcome measures. This three-phase project focuses
on cross-cutting and condition-specific outcome measures. Specifically,
outcome measures will be endorsed for patients with Medicare high
priority conditions, such as: Congestive heart failure, chronic
obstructive pulmonary disease, arthritis, diabetes, depression, and
several types of cancers. There is also a phase of work dedicated to
outcome measures for children. The conditions included in each phase
are:
[cir] Phase I: Cardiovascular diseases, including acute myocardial
infarction, ischemic heart disease, congestive heart failure, atrial
fibrillation, and stroke/transient ischemic attacks, metabolic
diseases, including diabetes and chronic kidney disease; and pulmonary
diseases, including asthma and chronic obstructive pulmonary disease.
[cir] Phase II: Cancer, including breast, lung, colorectal, and
endometrial cancers; bone/joint diseases, including hip fracture,
osteoporosis, and arthritis; and infection, including pneumonia.
[cir] Phase III: Child health and mental health. In future years,
measures derived from this phase include a core measure set for the
Children's Health Insurance Program Reauthorization Act of 2009.
Nursing home measures. This project focuses on the
endorsement of performance measures for nursing homes. It will include
an updated set of measures to assess and improve care provided in
nursing homes.
Patient Safety. NQF has a sizable portfolio of endorsed serious
reportable events, patient safety measures, and safe practices that are
used extensively by DHHS and states in reporting and payment programs,
and by providers for improvement purposes. On October 6, 2009, NQF
convened the Patient Safety Advisory Committee to assess current
initiatives and develop a two-year strategic work plan for the
evolution of the NQF portfolio. This strategic plan, when completed in
fall 2010, will guide NQF's safety work in 2011 and 2012. The initial
set of 2009 projects focuses on known gap areas.
Serious Reportable Events (SREs). NQF has long been a
pioneer in this area, dating to its 2002 report Serious Reportable
Events in Healthcare: A Consensus Report, which listed 27 preventable
events leading to death or serious injury that should be publicly
reported. (The program was updated in 2006, with a 28th event added.)
This list formed the core of the Medicare non-payment program for
healthcare-acquired conditions, as well as many state-based adverse
event reporting initiatives. This project will consider
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expanding the list of serious reportable events to include events that
are applicable to additional non-hospital settings, such as nursing
homes and ambulatory care settings. The project includes convening
representatives of state-based adverse event-reporting agencies to
review the current environment of adverse event reporting systems,
related issues, and unintended consequences, as well as to obtain their
input on the next generation of events.
Patient safety measures. This project focuses on key
safety measures such as healthcare-associated infections. As a part of
this project, currently endorsed infection measures will be updated to
reflect updated case definitions from the Centers for Disease Control
and Prevention. Other focus areas for patient safety measures will
include condition specific measures and reviewing applicability of
safety measures to a variety of environments of care.
Patient safety public reporting guidelines. Public
reporting of patient safety performance results can be challenging,
especially for serious reportable events and low-frequency safety
events. This project aims to develop a framework and guidelines for
measuring, evaluating, and publicly reporting patient safety
information across the spectrum for severity and frequency of events.
Maintenance of Previously Endorsed Measures (Task 8)
Healthcare performance measures and similar consensus standards are
useful for improving quality only as long as the standards reflect
current knowledge and state-of-the art, high-quality care. The
maintenance of NQF-endorsed measures is of critical importance because
the science underlying both clinical practice and safe, effective, and
efficient care delivery evolves over time. Ongoing maintenance
processes also ensure that measure specifications reflect updates in
coding systems, such as ICD-10-CM.
Specifically, the currency of the NQF portfolio refers to four
factors:
1. Importance of the Measure Topic. Does the measure reflect
current clinical science and guidelines? Is there still a gap between
actual and ideal performance? (Or is the measure ``topped out?'')
2. Measure Specifications. Do the specifications reflect current
coding and classification systems? (In addition, as discussed below,
future maintenance processes will require stewards to submit e-
specifications so measures can be used with electronic health records.)
3. Harmonization. There are currently dozens of measure developers,
all of whom follow different conventions and practices when specifying
measures. Through its endorsement and maintenance processes, NQF works
with measure stewards to harmonize their measures. Harmonization
facilitates the use of measures in sets (e.g., a composite measure for
patients with diabetes that reflects the outcomes and clinical process
measures for a patient-focused episode) and makes it easier to
understand and interpret results. Harmonization also lessens the burden
of implementation.
4. Best in Class. There is much innovation in the development of
measures. NQF-endorsed measures are subject to a competitive review
every three years in which they must demonstrate ``best in class'' when
compared directly with other candidate measures.
In 2009, NQF developed a comprehensive schedule for review of
measures pertaining to the leading conditions and the National
Priorities Partnership cross-cutting areas. The new measure maintenance
schedule will provide an annual update of measure specifications.
Measures will undergo a comprehensive review at least every three
years, including harmonization and best in class considerations. In
addition to scheduled maintenance, ad hoc maintenance reviews are
conducted if there are significant changes in the science base
requiring immediate attention or concerns are raised about untoward
consequences of measurement.
Promotion of EHRs (Task 9)
It is broadly recognized that EHR systems can improve the quality
of care delivered to patients. Health information technology (HIT)-
enabled content and transactions can make important healthcare
information more readily available to those who need it when they need
it. If implemented with careful attention to workflow and content
needs, EHR systems will appreciably improve the safety, effectiveness,
and efficiency of American healthcare, leading to widespread and
sustainable quality improvement. Such systems will support clinical
decisions; grant patients and clinicians access to health records and
improve the accuracy of those records; seamlessly integrate clinical
and payment functions; and facilitate the collection, reporting, and
analysis of quality data.
The ``eMeasure.'' In 2009, NQF developed and oversaw
standardization of the Health Quality Measure Format, commonly known as
the ``eMeasure,'' representing a health quality 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 a critical component of the workflow to support
``meaningful use'' of electronic records as described by the American
Recovery and Reinvestment Act of 2009. The eMeasure was successfully
balloted by the technical standards development organization HL7 at its
September 2009 workgroup meeting. The sponsoring workgroup, Structured
Documents, approved the ballot as a draft standard for trial use on
November 4, 2009. The measure was successfully tested in the HITSP
Connectathon in January 2010.
Measure Retooling. In 2009, under the DHHS contract, NQF
undertook implementation of its previously completed Quality Data Set
(QDS) \5\ (see Exhibit C) by applying the QDS to measures already
endorsed by NQF. NQF staff created an authoring environment for the
retooling effort to manage consistency with the QDS and to make the
process as efficient as possible. That environment is complete and will
be used by measure developers to retool high-priority measures
requested by CMS.
QDS Model and Repository. In the contract's first year,
some work on standardizing the management of code lists was performed
in the standards harmonization process in the Healthcare Information
Technology Standards Panel (HITSP) in summer 2009. The HIT Standards
Committee has now established a task force on vocabulary, which began
work in January 2010 to define the governance and infrastructure rules
for vocabulary management. NQF's participation in that task force
supports the registry requirements in a stand.
Exhibit C: About the QDS
The Quality Data Set (QDS), 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 quality measures. It is a classification system
by which measure developers can offer and refine definitions. Once
fully developed, the QDS will be a centralized repository of quality
data requirements (such as concepts, data types, data elements, and
code lists) and data definitions used by multiple stakeholders to
develop, specify, and use quality measures. The QDS aims to provide
direction to
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measure developers, EHR vendors, and other stakeholders on how to
define quality terminology without ambiguity. Although the QDS was
developed under an earlier grant from the Agency for Healthcare
Research and Quality, its implementation is covered under the current
DHHS contract.ard manner.
Measure Authoring Tool and Guidelines. In 2009, NQF
identified requirements for a measure authoring tool and created a
prototype environment for use in the measure retooling effort. An NQF
tooling/retooling guide is planned that will expand on that effort, and
a more detailed authoring tool will be available for use to create
electronic measures in January 2011.
Linking Performance Measurement to Clinical Decision
Support. NQF convened a Clinical Decision Support Expert Panel, which
met on November 11-12, 2009. The panel created a clinical decision
support taxonomy framework and adapted the QDS data requirements to
support clinical decision support.
The Development of a Public Web Site (Task 11)
NQF in 2009 undertook an effort to redevelop its own Web site to
guarantee that its proceedings would be fully transparent to all
stakeholders. The Web site, https://www.qualityforum.org, is now fully
operational and features an electronic measure submission form to
enhance the Consensus Development Process and measure maintenance
activities. Specifically, funding from the DHHS contract in this task
was used to:
Produce a new Web site for information about NQF's
Consensus Development Process and its specific projects, including
their status and opportunities for public and member input;
Implement additional Web site features; and
Perform ongoing management of web-based content.
The site was developed and is operated using a content management
system to support better content organization and maintenance and
editorial oversight. The implementation included integration with other
NQF systems and laid a technological foundation that will enable future
enhancements. Achievements resulting from this work include:
A new structure for project information that clearly
presents the progress of work through NQF's Consensus Development
Process and supports and encourages public review and input;
Site personalization for registered users, including a
dashboard in which users can access information about their
participation in NQF activities;
An online measure submission form and process that
improves the electronic collection and dissemination of the information
needed to evaluate performance measures for potential endorsement;
An improved online voting platform, including the ability
for users to see the status of their organization's participation; and
An online directory of NQF-endorsed consensus standards.
Measurement Development, Harmonization, and Endorsement (Task 12)
The DHHS contract provides for measure development and related
activities to fill gap areas. In 2009, NQF published requests for
proposals for ``indefinite need, indefinite quantity'' contracts to
build capacity in case DHHS decides that performance measures are
needed in any given area. This capacity was not requested by DHHS in
the first year of the contract. Other specific projects under this task
included:
Harmonization. To identify gaps in appropriate care at the
appropriate junctures, work is needed to adopt global, harmonized
quality measures in all settings. The opportunity to link measurement
across providers and sites of care will form the foundation for a
systems-based perspective to healthcare delivery, the reduction or
elimination of preventable illnesses, and the delivery of high-quality
care. Thus, NQF is planning to identify the steps needed to achieve
harmonization, including how to encourage measure developers to achieve
measure harmonization with measures across sites and providers of care.
This work is ongoing.
Efficiency and resource use measures. The current
portfolio of NQF measures contains very limited numbers of performance
measures to assess efficiency and resource use. In its new phase of
work, NQF has received 18 measures in mammography, appropriate use of
CT scans, and cardiac imaging. A second phase of work will focus on
measures of episode-based resource use.
ICD-10. DHHS utilizes various code sets to classify
medical care for purposes of payment and performance measurement. The
International Classification of Diseases (ICD) code set \6\ is used to
identify diagnoses (diseases, injuries, and impairments) and procedures
(diagnosing, managing, treating, preventing). DHHS intends to convert
from the ICD, Ninth Revision (ICD-9) to ICD, Tenth Revision, Clinical
Modification (ICD-10-CM) by 2013. In this project, NQF is examining the
implications of additional code set requirements on performance
measures and developing guidance and a schedule for updating measures
by the 2013 coding conversion deadline. In 2009, NQF convened an expert
panel to consider coding issues and how they affect performance
measurement, including defining and laying out a process for responding
to ``material changes'' in measures that may result from the coding
conversion process. This work is ongoing.
4. 2010 and Beyond: A Look Ahead
The decade since IOM published To Err is Human has seen the
maturation of the modern-day healthcare quality improvement movement in
the United States. It is no longer accepted as a matter of faith that
the United States boasts the ``best healthcare system in the world.''
Today, we know that despite the heroic effort of millions of dedicated
individuals, healthcare quality is deficient in many areas. Further, we
know that healthcare quality is measurable, and that quality
deficiencies must be measured--with the results of these measurements
publicly reported--if we hope to correct them. This recognition, while
sobering, has led to a national commitment to improve the quality of
healthcare for all Americans. Following this commitment, the
recognition has led to the construction of a national infrastructure
for quality improvement--including the formulation of national
priorities, the use of agreed-upon performance measures to gauge
quality, and an EHR system to collect and disseminate performance data.
As the quality movement has matured, so too has the National
Quality Forum. When the President's Advisory Commission on Consumer
Protection and Quality in the Health Care Industry proposed the
creation of a forum that would convene disparate stakeholders to
formulate a national strategy for healthcare quality, the idea seemed
novel. Today, NQF is itself a firmly entrenched stakeholder, advocating
for healthcare quality improvement while serving no interest other than
that of the public at large.
NQF's work today supports key DHHS work outlined in the American
Recovery and Reinvestment Act of 2009 in three important ways:
Supporting the HIT provisions by ensuring that EHRs have
the necessary capabilities to foster performance measurement and public
reporting;
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Focusing performance improvement activities on reducing
healthcare-associated infections and enhancing chronic disease
outcomes; and
Identifying key gaps in the evidence base to sustain the
Recovery Act's comparative effectiveness research goals.
NQF remains firmly committed to a broad, quality-focused
transformation of the healthcare system, including supporting goals in
quality, access, and affordability that may be achieved through
national health reform legislation.
The focus of the American quality improvement endeavor has moved
beyond measures of process to include measures of outcomes that matter
most to patients. In response to soaring healthcare costs, efforts are
now underway to develop and endorse efficiency measures that can be
used to remove waste and unnecessary services from the healthcare
system. This shift is fraught with challenges as the healthcare
industry seeks to find and agree upon measures that are important,
scientifically acceptable, usable, and feasible--and is subject to
controversy because results of these measures will be used in payment
and public reporting programs.
The quality infrastructure we are building today will be important
for decades to come. It is a fundamental building block for
transforming the American healthcare system to provide patient-centered
care that is safe, effective, and affordable.
The National Quality Forum, Washington, DC, March 1, 2010.
5. Appendices and Notes
Appendix A: About National Quality Forum
The National Quality Forum is a nonprofit organization that aims
to improve the quality of healthcare for all Americans through
fulfillment of its three-part mission:
Setting national priorities and goals for performance
improvement;
Endorsing national consensus standards for measuring
and publicly reporting on performance; and
Promoting the attainment of national goals through
education and outreach programs.
NQF was created in 1999 at the recommendation of the President's
Advisory Commission on Consumer Protection and Quality in the Health
Care Industry.\7\ Today, it is uniquely positioned to serve as a
national coordinating and standard-setting center for performance
measures. The NQF Board of Directors includes public- and private-
sector representatives, with a simple majority of its at-large seats
held by consumers and those who purchase services on their behalf.
(See Appendix B.) It works collaboratively with multiple quality
alliances, and has unmatched experience in evaluating and endorsing
measures of healthcare performance, many of which are in widespread
use. From its inception, NQF sought to convene disparate
stakeholders to work toward the common goal of improving healthcare
quality by advancing performance measurement and public reporting.
NQF member organizations are organized into eight member councils--
consumers; purchasers; healthcare professionals; health plans;
provider organizations; public/community health agencies; quality
measurement, research and quality improvement organizations; and
suppliers and industry.
Adhering to the National Technology Transfer and Advancement Act
of 1995 (Pub. L. 104-113) \8\ and the Office of Management and
Budget's definition of consensus,\9\ NQF endorses performance
measures, best practices, serious reportable events, measurement
frameworks, and reporting guidelines through its formal Consensus
Development Process,\10\ which is designed to call for input and
carefully consider the interests of stakeholder groups from across
the healthcare industry. The strict adherence to this Consensus
Development Process qualifies NQF as a voluntary consensus
standards-setting organization, granting its endorsed measures and
best practices special legal standing. NQF's work can be divided
into three broad categories:
1. National Priorities and Goals. In 2008, NQF embarked on the
nation's largest effort to determine national priorities for
healthcare quality improvement. NQF convened the National Priorities
Partnership (NPP), a diverse group of 32 major national
organizations representing those who receive, pay for, deliver, and
evaluate healthcare. (See Appendix D.) The NPP, co-chaired by Donald
M. Berwick, MD, MPP, president and CEO of the Institute for
Healthcare Improvement, and Margaret E. O'Kane, president of the
National Committee for Quality Assurance, sought to set in motion a
national movement to deliver transformative improvements to the
nation's health and healthcare system. In 2008, the NPP released a
landmark action agenda, with six priorities to transform healthcare
during a time of severe economic strain by better investing
resources to fundamentally improve patient care and outcomes. These
priorities and the specific, measurable actions springing from them
guide much of NQF's ongoing work.
2. Endorsement of Consensus Standards. The careful evaluation
and endorsement of consensus standards is central to NQF's ongoing
mission to improve the quality of American healthcare. Using its
rigorous Consensus Development Process, NQF fosters consensus among
a wide variety of stakeholders around specific standards that can be
used to measure and publicly report healthcare quality. NQF endorses
several different kinds of consensus standards, each of which can be
used to assess different aspects of healthcare quality: performance
measures, practices, frameworks, and reporting guidelines. To date,
NQF has endorsed more than 550 consensus standards.
[cir] Performance Measures. Measures gauging the performance of
healthcare endorsed by NQF are used for measuring and publicly
reporting on the performance of different aspects of the healthcare
system and are widely viewed as the ``gold standard'' for the
measurement of healthcare quality. One early model for the
implementation of NQF endorsed performance measures was National
Voluntary Consensus Standards for Hospital Care: An Initial
Performance Measure Set.\11\ This report contained 39 performance
measures gauging the quality of care delivered in hospitals. It was
endorsed through NQF's Consensus Development Process. These hospital
measures took on additional importance when 10 of them became the
``starter set'' of measures employed by the Hospital Quality
Alliance \12\ and CMS's Hospital Compare \13\ to encourage public
reporting of hospital performance measures.
[cir] Patient Safety. NQF has an established track record of
national leadership regarding patient safety. Two of its very early
projects launched NQF's work in this area. The first was Serious
Reportable Events in Healthcare: A Consensus Report,\14\ in which
NQF named 27 events leading to death or serious injury that should
not occur in any healthcare setting, but unfortunately do, and
should be publicly reported when they do occur. These events and
their NQF revisions became the cornerstone of many state-based
adverse event-reporting initiatives and of CMS's policies regarding
payment for healthcare-acquired conditions. The second was Safe
Practices for Better Healthcare: A Consensus Report,\15\ a set of 30
practices that, if universally applied in all clinical care
settings, would substantially reduce the risk of error and harm for
patients. These practices have become the standard by which many
healthcare organizations measure their patient safety goals and
strategies. Both of these reports have been revised twice since
initial publication.
3. Education and Outreach. As part of its ongoing commitment to
the advancement of healthcare quality, NQF produces a variety of
publications, such as issue briefs; conducts educational outreach
sessions such as webinars; sponsors an annual conference that brings
together healthcare and community leaders to develop national
solutions to quality concerns; convenes healthcare executives
annually for an invitational Leadership Colloquium; and sponsors two
annual recognition programs, the National Quality Healthcare Award
and the John M. Eisenberg Patient Safety and Quality Awards,
highlighting the achievements of professionals and providers.
In 2008, Congress provided a clear mandate and a stable funding
stream to address gaps and weaknesses that stood between today's
realities and the creation of a coherent national system for
establishing performance measures. High-quality standardized
performance measures are a public need as well as a public good that
benefits all stakeholders. In 2009, NQF was awarded a contract with
DHHS under the Medicare Improvements for Patients and Providers Act
of 2008 (Pub. L. 110-275). The contract provided $10 million for
year after
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award, with the option for three $10 million annual renewals. This
contract granted NQF a stable source of core funding to pursue this
important work in a coordinated, strategic manner.
Today, NQF is one of the largest consensus-based organizations
in healthcare in the United States. Its more than 400 organizational
members represent every aspect of the U.S. healthcare system. It has
evolved into a truly broad, fully representational organization
supporting the nation's quest for a ``true north'' for healthcare
quality. Its strength lies in the active participation of its broad,
diverse membership. NQF's unique structure enables private- and
public-sector stakeholders to work together to craft and implement
cross-cutting solutions to drive continuous quality improvement in
the American healthcare system. NQF remains committed to maintaining
a constant drumbeat for healthcare quality.
Appendix B: NQF Board of Directors
William L. Roper, MD, MPH (Chair), Dean, School of Medicine, Vice
Chancellor for Medical Affairs and CEO, UNC Health Care System,
University of North Carolina at Chapel Hill.
John C. Rother, JD (Vice Chair), Executive Vice President for Policy
and Strategy, AARP.
Gerald M. Shea (Secretary), Assistant to the President for External
Affairs, AFL-CIO.
Richard J. Baron, MD, President and CEO, Greenhouse Internists.
Bruce Bagley, MD, Medical Director for Quality Improvement, American
Academy of Family Physicians.
Lawrence M. Becker, Director, HR Strategic Partnerships, Xerox
Corporation.
JudyAnn Bigby, MD, Secretary of Health & Human Services,
Commonwealth of Massachusetts.
Carolyn M. Clancy, MD, Director, Agency for Healthcare Research and
Quality.
Francis S. Collins, MD, PhD, Director, National Institutes of
Health.
Janet Corrigan, PhD, MBA, President and CEO, National Quality Forum.
Maureen Corry, MPH, Executive Director, Childbirth Connection.
Helen Darling, MA, President, National Business Group on Health.
Charlene Frizzera, Acting Administrator, Centers for Medicare &
Medicaid Services.
Robert Galvin, MD, Director of Global Healthcare, General Electric.
Wade Henderson, Esq., President and CEO, Leadership Conference on
Civil Rights.
Karen Ignagni, MBA, President & CEO, America's Health Insurance
Plans.
Chris Jennings, President, Jennings Policy Strategies, Inc.
Charles N. ``Chip'' Kahn III, MPH, President, Federation of American
Hospitals.
Peter V. Lee, JD, Executive Director of National Health Policy,
Pacific Business Group on Health.
Mark B. McClellan, MD, PhD, Director, Engelberg Center for
Healthcare Reform, Senior Fellow for Economic Studies, and Leonard
D. Schaeffer Chair in Health Policy Studies, The Brookings
Institution.
Sheri S. McCoy, MBA, Worldwide Chairman of the Pharmaceuticals
Group, Johnson & Johnson.
Harold D. Miller, President and CEO, Network for Regional Healthcare
Improvement.
Mary Naylor, PhD, RN, Marian S. Ware Professor in Gerontology at the
University of Pennsylvania School of Nursing, and Director of
NewCourtland Center for Transitions and Health.
Debra L. Ness, President, National Partnership for Women and
Families.
Nancy H. Nielsen, MD, PhD, Immediate Past President, American
Medical Association.
Samuel R. Nussbaum, MD, Executive Vice President & Chief Medical
Officer, WellPoint, Inc.
J. Marc Overhage, MD, PhD, Director of Medical Informatics,
Regenstreif Institute.
Bernard M. Rosof, MD, Chair, Board of Trustees, Huntington Hospital.
Joseph R. Swedish, President and CEO, Trinity Health.
Curt Selquist (Chair, Leadership Network, ex officio), Johnson &
Johnson Healthcare Systems, Inc. (retired).
John Tooker, MD, MBA, FACP, Executive Vice President and CEO,
American College of Physicians.
Richard J. Umbdenstock, MS, FACHE, President and CEO, American
Hospital Association.
Andrew Webber, President and CEO, National Business Coalition on
Health.
Appendix C: Key NQF Staff Working Under the DHHS
Janet M. Corrigan, PhD, MBA, President and Chief Executive Officer.
Helen Burstin, MD, MPH, Senior Vice President for Performance
Measures.
Floyd Eisenberg, MD, MPH, FACP, Senior Vice President for Health
Information Technology.
Laura Miller, MPA, Senior Vice President and Chief Operating
Officer.
Thomas Valuck, MD, MHSA, JD, Senior Vice President for Strategic
Partnerships.
Karen Adams, PhD, Vice President of National Priorities.
Alicia C. Aebersold, Vice President of Communications.
Marybeth A. Farquhar, PhD, MSN, RN, Vice President for Performance
Measures.
Lawrence D. Gorban, MA, Vice President of Operations.
Bruce Pelleu, CPA, Chief Financial Officer.
Peter B. Angood, MD, FRCS(C), FACS, FCCM, Senior Advisor, Patient
Safety.
Alexis Forman, MPH, Program Director, Performance Measures.
Margaret Kay, Director of Publications.
Lindsay Lang, MHSA, RN, Program Director, Performance Measures.
Nicole Williams McElveen, MPH, Program Director, Performance
Measures.
Karen Pace, PhD, RN, Senior Program Director.
Ashlie Wilbon, MPH, RN, Program Director, Performance Measures.
Appendix D: National Priorities Partnership
AAR
AFL-CIO
Agency for Healthcare Research and Quality
Aligning Forces for Quality
Alliance for Pediatric Quality
America's Health Insurance Plans
American Board of Medical Specialties
American Health Care Association
American Nurses Association
AQA
Centers for Disease Control and Prevention
Centers for Medicare & Medicaid Services
Certification Commission for Health Information Technology
Consumers Union
Hospital Quality Alliance
Institute for Healthcare Improvement
Institute of Medicine
Johnson & Johnson
Leapfrog Group
National Association of Community Health Centers
National Business Group on Health
National Committee for Quality Assurance
National Governors Association
National Institutes of Health
National Partnership for Women & Families
National Quality Forum
Pacific Business Group on Health
Physician Consortium for Performance Improvement convened by the
American Medical Association
PQA
Quality Alliance Steering Committee
The Joint Commission
U.S. Chamber of Commerce
Notes
\1\ Kohn LT, Corrigan JM, Donaldson MS, eds. To Err is Human:
Building a Safer Health System. Committee on Quality of Health Care
in America, Institute of Medicine. Washington, DC: National Academy
Press; 2000.
\2\ Medicare Improvements for Patients and Providers Act (Pub.
L. 110-275). Available online at https://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=110_cong_bills&docid=f:h6331enr.txt.pdf.
Last accessed December 2009.
\3\ National Priorities Partnership (NPP). Available online at
https://www.nationalprioritiespartnership.org/. Last accessed
December 2009.
\4\ NPP. National Priorities & Goals: Aligning Our Efforts to
Transform America's Healthcare. Washington, DC: National Quality
Forum (NQF); 2008.
\5\ NQF. Policy Brief: HITEP II. Issue Brief No. 17; October
2009. Washington, DC: NQF; 2009.
\6\ International Classification of Diseases. Available at
https://www.who.int/classifications/icd/en/. Last accessed January
2010.
\7\ President's Advisory Commission on Consumer Protection and
Quality in the Health Care Industry. Quality First: Better Health
Care for All Americans. March 12, 1998. Available online at https://www.hcqualitycommission.gov/final/. Last accessed December 2009.
\8\ National Technology Transfer and Advancement Act of 1998
(Pub. L. 104-113). Available online at https://ts.nist.gov/standards/information/113.cfm. Last accessed December 2009.
\9\ U.S. Office of Management and Budget. Circular No. A-119,
February 10, 1998.
[[Page 65349]]
Available online at https://www.whitehouse.gov/omb/rewrite/circulars/a119/a119.html. Last accessed December 2009.
\10\ NQF. NQF Consensus Development Process, v. 1.8. Available
online at https://www.qualityforum.org/Measuring_Performance/Consensus_Development_Process.aspx. Last accessed December 2009.
\11\ NQF. National Voluntary Consensus Standards for Hospital
Care: An Initial Performance Measure Set. Washington, DC: NQF; 2003.
\12\ Hospital Quality Alliance: Improving Care Through
Information. Available online at https://www.hospitalqualityalliance.org/. Last accessed December 2009.
\13\ Hospital Quality Compare--A quality tool provided by
Medicare. Available online at www.HospitalCompare.hhs.gov. Last
accessed December 2009.
\14\ NQF. Serious Reportable Events in Healthcare: A Consensus
Report. Washington, DC: NQF; 2002.
\15\ NQF. Safe Practices for Better Healthcare: A Consensus
Report. Washington, DC: NQF; 2003.
IV. Secretarial Comments on the Annual Report to Congress
The Secretary is pleased with the scope and vision of NQF's March
2010 annual report. An internal multidisciplinary cross-component HHS
team is working collaboratively with NQF to ensure a clear multi-year
vision to ensure the most efficient and effective utilization of the
HHS contract. The contract with this consensus-based entity, 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 to ensure broad transparency in achieving value in
health care delivery.
Over the past year NQF began work on several tasks outlined in the
Statement of Work, including: Development of a national strategy for
performance measurement and prioritization of measures for development
and endorsement; an evaluation of NQF's consensus development process;
several measure endorsement projects fo