Secretarial Review and Publication of the Annual Report to Congress Submitted by the Contracted Consensus-Based Entity Regarding Performance Measurement, 55474-55499 [2011-22624]

Agencies

• DEPARTMENT OF HEALTH AND HUMAN SERVICES

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



[[Page 55473]]

Vol. 76

Wednesday,

No. 173

September 7, 2011

Part II





Department of Health and Human Services





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

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

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DEPARTMENT OF HEALTH AND HUMAN SERVICES


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

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

ACTION: Notice.

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

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

I. Background

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

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

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

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

III. NQF March 2011 Annual Report

Advancing Performance Measurement: NQF Report to Congress 2011

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

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

Table of Contents

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

Foreword

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

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

Notes

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

I. Executive Summary

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

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

National Priorities

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

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

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

[[Page 55477]]

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

Prioritized List of 20 High-Impact Medicare Conditions*

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

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

Performance Measures

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

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

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

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Technical Infrastructure To Support Measurement Using an Electronic 
Platform

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

Measure Selection for Applications

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

[[Page 55479]]

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

Summary

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

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

II. About the National Quality Forum

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

NQF Consensus Development Process

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

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

[[Page 55480]]

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

Notes

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

III. About the Contract

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

[[Page 55481]]

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

IV. HHS-Funded Work

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

National Strategy and Priorities (Task 6)

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

Prioritized List of 20 High-Impact Medicare Conditions*

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

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

[[Page 55482]]

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

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

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

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

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

[[Page 55483]]

prolonged and needless suffering and ineffective treatments.
    In 2006, NQF endorsed a framework and preferred practices for 
palliative and hospice care quality.\3\ NPP has identified palliative 
care as a priority area for national action. In 2010, NQF began 
planning for a project that would seek to endorse performance measures 
to gauge the quality of palliative and end-of-life care. This project 
is slated to begin in early 2011.
Nursing Homes
    NQF was an early pioneer in advancing measures of nursing home care 
quality, endorsing an initial set of performance measures in this area 
in 2004.\4\ Building on this work, in 2009 NQF initiated a project to 
consider additional performance measures