Secretarial Review and Publication of the National Quality Forum Report of 2016 Activities to Congress and the Secretary of the Department of Health and Human Services, 39797-39874 [2017-17734]
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Federal Register / Vol. 82, No. 161 / Tuesday, August 22, 2017 / Notices
183(a)(1) of the Medicare Improvements
for Patients and Providers Act of 2008
(MIPPA) (Pub. L. 110–275), requires the
Secretary to identify and have in effect
a contract with a consensus-based entity
(CBE) to perform multiple duties
described in subsection (b) that are
designed to help improve performance
measurement. The duties described in
subsection (b) originally included a
priority setting process, measure
endorsement, measure maintenance,
electronic health record promotion, and
the preparation of an annual Report to
Congress and the Secretary. Section
3003(b) of the Patient Protection and
Affordable Care Act (Pub. L. 111–148) as
amended by the Health Care and
Education Reconciliation Act (Pub. L.
Dated: August 17, 2017.
111–152) (collectively, the Affordable
Leslie Kux,
Care Act) expanded the duties of the
Associate Commissioner for Policy.
CBE to require the CBE to review and,
[FR Doc. 2017–17701 Filed 8–21–17; 8:45 am]
as appropriate, endorse the episode
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grouper developed by the Secretary
under the Physician Feedback Program.
Section 3014(a)(1) of the Affordable
DEPARTMENT OF HEALTH AND
Care Act further expanded the duties to
HUMAN SERVICES
require the CBE to convene multistakeholder groups to provide input on
[CMS–3340–N]
the selection of quality and efficiency
measures and national priorities for
Secretarial Review and Publication of
improvement in population health and
the National Quality Forum Report of
in the delivery of health care services
2016 Activities to Congress and the
for consideration under the national
Secretary of the Department of Health
strategy, and to transmit such input to
and Human Services
the Secretary. Section 3014(a)(2) of the
AGENCY: Office of the Secretary of
Affordable Care Act expanded the
Health and Human Services, HHS.
requirements for the annual report that
ACTION: Notice.
must be submitted under section
1890(b)(5)(A) of the Act.
SUMMARY: This notice acknowledges that
To meet the requirements of section
in accordance with section 1890(b)(5)(B) 1890(a) of the Act, in January of 2009,
of the Social Security Act (the Act) the
the Department of Health and Human
Secretary of the Department of Health
Services (HHS) awarded a competitive
and Human Services (the Secretary) has contract to the National Quality Forum
received and reviewed the National
(NQF). A second, multi-year contract
Quality Forum (NQF) Report of 2016
was awarded to NQF after an open
Activities to Congress and the Secretary competition in 2012. This contract
of the Department of Health and Human includes the following duties:
Services submitted by the consensusPriority Setting Process: Formulation
based entity with whom the Secretary
of a National Strategy and Priorities for
has a contract under section 1890(a) of
Health Care Performance Measurement.
the Act. The purpose of this Federal
The CBE is required to synthesize
Register notice is to publish the report,
evidence and convene key stakeholders
together with the Secretary’s comments
to make recommendations on an
on such report.
integrated national strategy and
priorities for health care performance
FOR FURTHER INFORMATION CONTACT:
measurement in all applicable settings.
Sophia Chan, (410) 786–5050.
In doing so, the CBE is to give priority
I. Background
to measures that: (1) Address the health
The Secretary of the Department of
care provided to patients with
Health and Human Services (the
prevalent, high-cost chronic diseases;
Secretary) has long recognized that a
(2) have the greatest potential for
high functioning health care system that improving quality, efficiency and
provides higher quality care requires
patient-centeredness of health care; and
accurate, valid, and reliable
(3) may be implemented rapidly due to
existing evidence, standards of care, or
measurement of quality and efficiency.
other reasons. Additionally, the CBE
Section 1890(a) of the Social Security
must take into account measures that:
Act (the Act), as added by section
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cosmetics will file 4,049 amendments to
product formulations on Forms FDA
2512 and FDA 2512a. Each submission
is estimated to take 0.17 hour per
response for a total of 688.33 hours,
rounded to 688. We estimate that,
annually, firms that manufacture, pack,
or distribute cosmetics will file 95
notices of discontinuance on Form FDA
2512. Each submission is estimated to
take 0.10 hour per response for a total
of 9.5 hours, rounded to 10. We estimate
that, annually, one firm will file one
request for confidentiality. Each such
request is estimated to take 2 hours to
prepare for a total of 2 hours. Thus, the
total estimated hour burden for this
information collection is 3,233 hours.
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(1) May assist consumers and patients in
making informed health care decisions;
(2) address health disparities across
groups and areas; and (3) address the
continuum of care a patient receives,
including across multiple providers,
practitioners and settings.
Endorsement of Measures. The CBE is
required to provide for the endorsement
of standardized health care performance
measures. This process must consider
whether measures are evidence-based,
reliable, valid, verifiable, relevant to
enhanced health outcomes, actionable at
the caregiver level, feasible to collect
and report, responsive to variations in
patient characteristics such as health
status, language capabilities, race or
ethnicity, and income level and
consistent across types of health care
providers, including hospitals and
physicians.
Maintenance of CBE Endorsed
Measures. The CBE is required to
establish and implement a process to
ensure that endorsed measures are
updated (or retired if obsolete) as new
evidence is developed.
Review and Endorsement of an
Episode Grouper Under the Physician
Feedback Program. ‘‘Episode-based’’
performance measurement is an
approach to better understanding the
utilization and costs associated with a
certain condition by grouping together
all the care related to that condition.
‘‘Episode groupers’’ are software tools
that combine data to assess such
condition-specific utilization and costs
over a defined period of time. The CBE
is required to provide for the review,
and as appropriate, endorsement of an
episode grouper as developed by the
Secretary on an expedited basis.
Convening Multi-Stakeholder Groups.
The CBE must convene multistakeholder groups to provide input on:
(1) The selection of certain categories of
quality and efficiency measures, from
among such measures that have been
endorsed by the entity; and such
measures that have not been considered
for endorsement by such entity but are
used or proposed to be used by the
Secretary for the collection or reporting
of quality and efficiency measures; and
(2) national priorities for improvement
in population health and in the delivery
of health care services for consideration
under the national strategy. The CBE
provides input on measures for use in
certain specific Medicare programs, for
use in programs that report performance
information to the public, and for use in
health care programs that are not
included under the Act. The multistakeholder groups provide input on
quality and efficiency measures for use
in certain federal programs including
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those that address certain Medicare
services provided through hospices,
hospital inpatient and outpatient
facilities, physician offices, cancer
hospitals, end stage renal disease
(ESRD) facilities, inpatient
rehabilitation facilities, long-term care
hospitals, psychiatric hospitals, and
home health care programs. For
Medicaid and the Children’s Health
Insurance Program (CHIP), the multistakeholder groups provide input on
measures to be included as part of the
Medicaid and CHIP Child and Adult
Core Sets.
Transmission of Multi-Stakeholder
Input. Not later than February 1 of each
year, the CBE is required to transmit to
the Secretary the input of multistakeholder groups.
Annual Report to Congress and the
Secretary. Not later than March 1 of
each year, the CBE is required to submit
to Congress and the Secretary of HHS an
annual report. The report is required to
describe the following:
• The implementation of quality and
efficiency measurement initiatives and
the coordination of such initiatives with
quality and efficiency initiatives
implemented by other payers;
• Recommendations on an integrated
national strategy and priorities for
health care performance measurement;
• Performance by the CBE on the
duties required under its contract with
HHS;
• Gaps in endorsed quality and
efficiency measures, including measures
that are within priority areas identified
by the Secretary under the national
strategy established under section
399HH of the Public Health Service Act
(National Quality Strategy), and where
quality and efficiency measures are
unavailable or inadequate to identify or
address such gaps;
• Areas in which evidence is
insufficient to support endorsement of
quality and efficiency measures in
priority areas identified by the Secretary
under the National Quality Strategy, and
where targeted research may address
such gaps; and
• The convening of multi-stakeholder
groups to provide input on: (1) the
selection of quality and efficiency
measures from among such measures
that have been endorsed by the CBE and
those that have not been considered for
endorsement by the CBE but are used or
proposed to be used by the Secretary for
the collection or reporting of quality and
efficiency measures; and (2) national
priorities for improvement in
population health and the delivery of
health care services for consideration
under the National Quality Strategy.
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The statutory requirements for the
CBE to annually Report to Congress and
the Secretary of HHS also specify that
the Secretary must review and publish
the CBE’s annual report in the Federal
Register, together with any comments
by the Secretary on the report, not later
than 6 months after receiving it.
This Federal Register notice complies
with the statutory requirement for
Secretarial review and publication of
the CBE’s annual report. NQF submitted
a report on its 2016 activities to the
Secretary on March 1, 2017. Comments
of the Secretary on this report are
presented below in section II and the
actual 2017 Annual Report to Congress
is provided as an addendum to this
Federal Register notice.
II. Secretarial Comments on the NQF
Report of 2016 Activities to Congress
and the Secretary of the Department of
Health and Human Services
Once again we thank the National
Quality Forum (NQF) and the many
stakeholders who participate in NQF
projects for helping to advance the
science and utility of health care quality
measurement. As part of its annual
recurring work to maintain a strong
portfolio of endorsed measures for use
across varied providers, settings of care,
and health conditions, NQF reports that
in 2016 it updated its portfolio of
approximately 600 endorsed measures
by reviewing and endorsing or reendorsing 197 measures and removing
87 measures. Endorsed measures
facilitate the goals of improving care for
highly prevalent conditions, fostering
better care and coordination, and
making the healthcare system more
responsive to patient and family needs.
These endorsed measures address a
wide range of health care topics relevant
to HHS programs, including: Personand family-centered care; care
coordination; palliative and end-of-life
care; cardiovascular care; behavioral
health; pulmonary/critical care;
perinatal care; cancer treatment; patient
safety; and cost and resource use.
In addition to adding and reendorsing new and existing measures,
some measures were also removed from
the portfolio for a variety of reasons (for
example, no longer meeting
endorsement criteria; harmonization
with other similar measures; retirement
by the measures developers;
replacement with improved measures;
and lack of continued need because
providers consistently perform at the
highest level on those measures). This
continuous refinement of the measures
portfolio through the measures
maintenance process ensures that
quality measures remain aligned with
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current field practices and health care
goals. NQF also reports that in 2016 it
continued to support the National
Quality Strategy (NQS) by endorsing
measures linked to the NQS priorities
and convening diverse stakeholder
groups to reach consensus on key
strategies for performance measurement.
In addition, in 2016 NQF undertook
and continued a number of projects to
address difficult quality measurement
issues and reduce the burden of quality
measures for clinicians. An important
area that NQF continued to address was
the issue of attribution, or the process
used to assign accountability for a
patient and his or her quality outcomes
to a clinician, a group of clinicians, or
a facility. HHS agrees that engaging
clinicians and clearly communicating
the methods and benchmarks used to
determine attribution are foundational
principles in quality measurement.
Having clear methods for attribution
helps clinicians understand the
information given to them from quality
measures, and allows for clinicians to
make actionable changes to their
clinical practices. When clinicians
receive meaningful feedback regarding
performance measurement, they can use
it to implement best practices. Clear
performance data reduce clinicians’
burden in deciphering quality
measurement information and allows
them to focus on how best to improve
care. While attribution models may
differ, clinician engagement,
transparency, and clear, usable data
remain fundamental to quality
measurement.
NQF’s work on attribution began in
2015 when NQF convened a multistakeholder committee to examine
attribution models and recommend
principles to guide the selection and
implementation of approaches. This
work has resulted in a thorough list of
potential approaches to validly and
reliably attribute performance
measurement results to one or more
clinicians under different delivery
models and to identify models of
attribution for potential testing. The
committee first convened in December
2015 and performed an environmental
scan to identify attribution models
currently in use and models that have
been proposed but not implemented.
The environmental scan identified 171
unique attribution models, 27 of which
have been implemented and 144 of
which remain proposals only. The
models differed across care settings,
payment models, and in methodology,
but there were also areas of similarity.
After reviewing and discussing the scan,
the committee defined several guiding
principles to inform the development of
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successful attribution models. In
addition, the committee developed an
Attribution Model Selection Guide and
outlined their findings in a report
published in December 2016. See
‘‘Attribution—Principles and
Approaches’’, National Quality Forum,
December 2016, https://www.quality
forum.org/Publications/2016/12/
Attribution_-_Principles_and_
Approaches.aspx.
Attribution is just one of many areas
in which NQF partners with HHS in
enhancing and protecting the health and
well-being of all Americans. Quality
measurement is essential to a highfunctioning healthcare system, as
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evidenced in many of the targeted
projects that NQF is being asked to
undertake. HHS greatly appreciates the
ability to bring many and diverse
stakeholders to the table to help develop
the strongest possible approaches to
quality measurement as a key
component of our healthcare system.
We look forward to a continued strong
partnership with the National Quality
Forum in this ongoing endeavor.
III. Collection of Information
Requirements
This document does not impose
information collection requirements,
that is, reporting, recordkeeping, or
third-party disclosure requirements.
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Consequently, there is no need for
review by the Office of Management and
Budget under the authority of the
Paperwork Reduction Act of 1995 (44
U.S.C. 3501 et seq.).
IV. Addendum
In this Addendum, we are publishing
the NQF Report on 2016 Activities to
Congress and the Secretary of the
Department of Health and Human
Services.
Dated: August 16, 2017.
Thomas E. Price,
Secretary, Department of Health and Human
Services.
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Quality and Efficiency Measurement Initiatives (Performance Measures)
Improve care for highly prevalent c:ondltioos,
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of cardiovascular
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Current State of NQf Measure Portfolio; Responding to Evolving Needs
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Completed Projects
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IV,
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Stakeholder Recommendations on
Priorities
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Measure Applications Partnership
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Gaps Identified in Completed Projects 2016
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lnteroperability
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Emergency Department Quality of Transitions of Care
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Improving DiagMstic Accuracy
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Core Quality Measures Collaborative- Private and Publit Alignment
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References
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HHS
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•
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What are the desired outcomes and results of the
program?
ls the attribution model evidence-b<~sed?
Is the attribution model aspirationali'
What is the accountability mechanism of the program?
Which entities will partic:lpate and act under the
actountability program?
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Subl:riterion 6.1
Subcriterion6.2
Subcriterion7.1
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.~~;.,,..,,.,,.uiho:
0: federal PubUc Reporting and Performance-Based Payment Programs
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Considered
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MAP
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of HHS's National
to HHS, MAP's
Coorrlin:>tirl!! Committee onwir!es
Conrrlin;>tir>" Committee on measures needed for
spe,c!t:IC
pa1:ier1t P'OP\Jiat:iorts Time-limited task forces consider more focused
deveiooiinl! "families of measures"-related measures that cross
further information to the MAP
indudes individuals with content
Committee and
and
and
popullati,ons~-an
Each multlstakellolcler group
affected
the work.
paramount. Due to the COIT11:l,le):itv
'"'>J"''"' matter
are included in the
""''vr>hr•"' because federal offil;ials cannot advise
groups. Federal ""''""'''m"nt
themselves. MAP members serve slaa~>·t>r<•d trmee-\Fea terms.
COMMITTEE CO-CHAIRS {VOTING)
Charles Kahn, Ill, MPH
Elizabeth A. Md51ynn, 1'110, Ml'l'
Armlemy <>! Manag"<! Core Pharma<¥
Mar1SS.() Schlaifer, RPh, M$
A<illaMe<l
Steven Brotman, MD, JD
AFl~IO
Shaw1 O'Brien
AmErleaFs Health tnsurance Ptans
Aparna Higgins, MA
American Board of Wdkal Spedahles.
R. Barrett Noone, MD, fACS
Americ•n A~adem)l <>I Family Physicians
Amy Mullins, MD, FAAFP
Americon
Amir Qaseern, MD1 PhD, MHA
American College of Surgeons
Frank G. Opelka, MD, FACS
Am~rican
Heah:hCare Assm::iation
~vidGiffon:.t,
MO, MPH
Amerkan Hospital A.s.sodat!on
Rhonda Anderson, RN, DillS<. FMN
Amerf:can Medical Association
Cad .A_" Slrio, MD
Amerk-an Medical Group Association
Sam Lin, MD, PhD, MBA
A.merkan l\h.tf'Ses Association
Weston~
PhD, RN
66
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Marla J,
39866
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Slue Cross and B!ue Shield Assodation
Consumers: Union
John
Hea!th:eare Finandaf Manageme-nt Association
Maine Health Management l:oalltlon
The Joint Commission
National Alllan<:e for Caregiving
National Association of Medicaid Directors
National Business Gmup M Health
MA
National Committee for Qutdity Assurance
NatforraJ ?artn~r:ship for Wom~n and fa mUtes
PhD,
Network fo-r Regional Heaithcare Improvement
Pharrrmeeuti<:at Research and Manufadurers of America ~PhRMA}
MBA
Rlohard Antonelli, MD, MS
Dor~s
lotz, MD} MPH
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Elixabe!h McGlynn, PhD, Ml'!'
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MAP Cllnidan Workgroup
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Al\liOA ~ Tlw Society lor Post-Acute •nd LMf!·Term Care 1\/iedl<ine
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39872
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39873
MAP Medicaid Child Task forte
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Aetna
39874
Federal Register / Vol. 82, No. 161 / Tuesday, August 22, 2017 / Notices
MAP Dual
Jennie Chin Ha....,, RN, MS, MAN
Nancy Ha:nraht:U1:1
PhD~ RN~
FAAN
MRl' 1'\Jblic l'.olky Institute
RN,
1\MDI\- The 5<><1"1¥ lor l'osi·A<ute and long-Term Carn Medici""
Ass<><latlon for Community Affiliated Health Plans
Homewiitch Care.Gfvers
MN,
Humana, inc.
MBA
National Association of Medkaid Directors
BSN,
Natlnnall\ssodation o! Social Workers
EXPERT
INDIV!DUAL SUBJECT
Mally Chalk, MSW, 1'110
lames Dun!onl, Mtl
K. Ch•rlie lakin, l'hD
Ruth Perry, MO
Kimberly Rasl<, MO, !'110
Gail Stuart:, PliO, IIIII
Administration for Community living {Att}
National Quality Forum
1030 15th
Suite 800
Wa:shirrgton, DC :10005
ISBN 978-Hi8248-044·1
©2017 National Quality Forum
[FR Doc. 2017–17734 Filed 8–21–17; 8:45 am]
BILLING CODE 4150–28–C
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75
]]>Agencies
[Federal Register Volume 82, Number 161 (Tuesday, August 22, 2017)]
[Notices]
[Pages 39797-39874]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2017-17734]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
[CMS-3340-N]
Secretarial Review and Publication of the National Quality Forum
Report of 2016 Activities to Congress and the Secretary of the
Department of Health and Human Services
AGENCY: Office of the Secretary of Health and Human Services, HHS.
ACTION: Notice.
-----------------------------------------------------------------------
SUMMARY: This notice acknowledges that in accordance with section
1890(b)(5)(B) of the Social Security Act (the Act) the Secretary of the
Department of Health and Human Services (the Secretary) has received
and reviewed the National Quality Forum (NQF) Report of 2016 Activities
to Congress and the Secretary of the Department of Health and Human
Services submitted by the consensus-based entity with whom the
Secretary has a contract under section 1890(a) of the Act. The purpose
of this Federal Register notice is to publish the report, together with
the Secretary's comments on such report.
FOR FURTHER INFORMATION CONTACT: Sophia Chan, (410) 786-5050.
I. Background
The Secretary of the Department of Health and Human Services (the
Secretary) has long recognized that a high functioning health care
system that provides higher quality care requires accurate, valid, and
reliable measurement of quality and efficiency. Section 1890(a) of the
Social Security Act (the Act), as added by section 183(a)(1) of the
Medicare Improvements for Patients and Providers Act of 2008 (MIPPA)
(Pub. L. 110-275), requires the Secretary to identify and have in
effect a contract with a consensus-based entity (CBE) to perform
multiple duties described in subsection (b) that are designed to help
improve performance measurement. The duties described in subsection (b)
originally included a priority setting process, measure endorsement,
measure maintenance, electronic health record promotion, and the
preparation of an annual Report to Congress and the Secretary. Section
3003(b) of the Patient Protection and Affordable Care Act (Pub. L. 111-
148) as amended by the Health Care and Education Reconciliation Act
(Pub. L. 111-152) (collectively, the Affordable Care Act) expanded the
duties of the CBE to require the CBE to review and, as appropriate,
endorse the episode grouper developed by the Secretary under the
Physician Feedback Program. Section 3014(a)(1) of the Affordable Care
Act further expanded the duties to require the CBE to convene multi-
stakeholder groups to provide input on the selection of quality and
efficiency measures and national priorities for improvement in
population health and in the delivery of health care services for
consideration under the national strategy, and to transmit such input
to the Secretary. Section 3014(a)(2) of the Affordable Care Act
expanded the requirements for the annual report that must be submitted
under section 1890(b)(5)(A) of the Act.
To meet the requirements of section 1890(a) of the Act, in January
of 2009, the Department of Health and Human Services (HHS) awarded a
competitive contract to the National Quality Forum (NQF). A second,
multi-year contract was awarded to NQF after an open competition in
2012. This contract includes the following duties:
Priority Setting Process: Formulation of a National Strategy and
Priorities for Health Care Performance Measurement. The CBE is required
to synthesize evidence and convene key stakeholders to make
recommendations on an integrated national strategy and priorities for
health care performance measurement in all applicable settings. In
doing so, the CBE is to give priority to measures that: (1) Address the
health care provided to patients with prevalent, high-cost chronic
diseases; (2) have the greatest potential for improving quality,
efficiency and patient-centeredness of health care; and (3) may be
implemented rapidly due to existing evidence, standards of care, or
other reasons. Additionally, the CBE must take into account measures
that: (1) May assist consumers and patients in making informed health
care decisions; (2) address health disparities across groups and areas;
and (3) address the continuum of care a patient receives, including
across multiple providers, practitioners and settings.
Endorsement of Measures. The CBE is required to provide for the
endorsement of standardized health care performance measures. This
process must consider whether measures are evidence-based, reliable,
valid, verifiable, relevant to enhanced health outcomes, actionable at
the caregiver level, feasible to collect and report, responsive to
variations in patient characteristics such as health status, language
capabilities, race or ethnicity, and income level and consistent across
types of health care providers, including hospitals and physicians.
Maintenance of CBE Endorsed Measures. The CBE is required to
establish and implement a process to ensure that endorsed measures are
updated (or retired if obsolete) as new evidence is developed.
Review and Endorsement of an Episode Grouper Under the Physician
Feedback Program. ``Episode-based'' performance measurement is an
approach to better understanding the utilization and costs associated
with a certain condition by grouping together all the care related to
that condition. ``Episode groupers'' are software tools that combine
data to assess such condition-specific utilization and costs over a
defined period of time. The CBE is required to provide for the review,
and as appropriate, endorsement of an episode grouper as developed by
the Secretary on an expedited basis.
Convening Multi-Stakeholder Groups. The CBE must convene multi-
stakeholder groups to provide input on: (1) The selection of certain
categories of quality and efficiency measures, from among such measures
that have been endorsed by the entity; and such measures that have not
been considered for endorsement by such entity but are used or proposed
to be used by the Secretary for the collection or reporting of quality
and efficiency measures; and (2) national priorities for improvement in
population health and in the delivery of health care services for
consideration under the national strategy. The CBE provides input on
measures for use in certain specific Medicare programs, for use in
programs that report performance information to the public, and for use
in health care programs that are not included under the Act. The multi-
stakeholder groups provide input on quality and efficiency measures for
use in certain federal programs including
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those that address certain Medicare services provided through hospices,
hospital inpatient and outpatient facilities, physician offices, cancer
hospitals, end stage renal disease (ESRD) facilities, inpatient
rehabilitation facilities, long-term care hospitals, psychiatric
hospitals, and home health care programs. For Medicaid and the
Children's Health Insurance Program (CHIP), the multi-stakeholder
groups provide input on measures to be included as part of the Medicaid
and CHIP Child and Adult Core Sets.
Transmission of Multi-Stakeholder Input. Not later than February 1
of each year, the CBE is required to transmit to the Secretary the
input of multi-stakeholder groups.
Annual Report to Congress and the Secretary. Not later than March 1
of each year, the CBE is required to submit to Congress and the
Secretary of HHS an annual report. The report is required to describe
the following:
The implementation of quality and efficiency measurement
initiatives and the coordination of such initiatives with quality and
efficiency initiatives implemented by other payers;
Recommendations on an integrated national strategy and
priorities for health care performance measurement;
Performance by the CBE on the duties required under its
contract with HHS;
Gaps in endorsed quality and efficiency measures,
including measures that are within priority areas identified by the
Secretary under the national strategy established under section 399HH
of the Public Health Service Act (National Quality Strategy), and where
quality and efficiency measures are unavailable or inadequate to
identify or address such gaps;
Areas in which evidence is insufficient to support
endorsement of quality and efficiency measures in priority areas
identified by the Secretary under the National Quality Strategy, and
where targeted research may address such gaps; and
The convening of multi-stakeholder groups to provide input
on: (1) the selection of quality and efficiency measures from among
such measures that have been endorsed by the CBE and those that have
not been considered for endorsement by the CBE but are used or proposed
to be used by the Secretary for the collection or reporting of quality
and efficiency measures; and (2) national priorities for improvement in
population health and the delivery of health care services for
consideration under the National Quality Strategy.
The statutory requirements for the CBE to annually Report to
Congress and the Secretary of HHS also specify that the Secretary must
review and publish the CBE's annual report in the Federal Register,
together with any comments by the Secretary on the report, not later
than 6 months after receiving it.
This Federal Register notice complies with the statutory
requirement for Secretarial review and publication of the CBE's annual
report. NQF submitted a report on its 2016 activities to the Secretary
on March 1, 2017. Comments of the Secretary on this report are
presented below in section II and the actual 2017 Annual Report to
Congress is provided as an addendum to this Federal Register notice.
II. Secretarial Comments on the NQF Report of 2016 Activities to
Congress and the Secretary of the Department of Health and Human
Services
Once again we thank the National Quality Forum (NQF) and the many
stakeholders who participate in NQF projects for helping to advance the
science and utility of health care quality measurement. As part of its
annual recurring work to maintain a strong portfolio of endorsed
measures for use across varied providers, settings of care, and health
conditions, NQF reports that in 2016 it updated its portfolio of
approximately 600 endorsed measures by reviewing and endorsing or re-
endorsing 197 measures and removing 87 measures. Endorsed measures
facilitate the goals of improving care for highly prevalent conditions,
fostering better care and coordination, and making the healthcare
system more responsive to patient and family needs. These endorsed
measures address a wide range of health care topics relevant to HHS
programs, including: Person- and family-centered care; care
coordination; palliative and end-of-life care; cardiovascular care;
behavioral health; pulmonary/critical care; perinatal care; cancer
treatment; patient safety; and cost and resource use.
In addition to adding and re-endorsing new and existing measures,
some measures were also removed from the portfolio for a variety of
reasons (for example, no longer meeting endorsement criteria;
harmonization with other similar measures; retirement by the measures
developers; replacement with improved measures; and lack of continued
need because providers consistently perform at the highest level on
those measures). This continuous refinement of the measures portfolio
through the measures maintenance process ensures that quality measures
remain aligned with current field practices and health care goals. NQF
also reports that in 2016 it continued to support the National Quality
Strategy (NQS) by endorsing measures linked to the NQS priorities and
convening diverse stakeholder groups to reach consensus on key
strategies for performance measurement.
In addition, in 2016 NQF undertook and continued a number of
projects to address difficult quality measurement issues and reduce the
burden of quality measures for clinicians. An important area that NQF
continued to address was the issue of attribution, or the process used
to assign accountability for a patient and his or her quality outcomes
to a clinician, a group of clinicians, or a facility. HHS agrees that
engaging clinicians and clearly communicating the methods and
benchmarks used to determine attribution are foundational principles in
quality measurement. Having clear methods for attribution helps
clinicians understand the information given to them from quality
measures, and allows for clinicians to make actionable changes to their
clinical practices. When clinicians receive meaningful feedback
regarding performance measurement, they can use it to implement best
practices. Clear performance data reduce clinicians' burden in
deciphering quality measurement information and allows them to focus on
how best to improve care. While attribution models may differ,
clinician engagement, transparency, and clear, usable data remain
fundamental to quality measurement.
NQF's work on attribution began in 2015 when NQF convened a multi-
stakeholder committee to examine attribution models and recommend
principles to guide the selection and implementation of approaches.
This work has resulted in a thorough list of potential approaches to
validly and reliably attribute performance measurement results to one
or more clinicians under different delivery models and to identify
models of attribution for potential testing. The committee first
convened in December 2015 and performed an environmental scan to
identify attribution models currently in use and models that have been
proposed but not implemented. The environmental scan identified 171
unique attribution models, 27 of which have been implemented and 144 of
which remain proposals only. The models differed across care settings,
payment models, and in methodology, but there were also areas of
similarity. After reviewing and discussing the scan, the committee
defined several guiding principles to inform the development of
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successful attribution models. In addition, the committee developed an
Attribution Model Selection Guide and outlined their findings in a
report published in December 2016. See ``Attribution--Principles and
Approaches'', National Quality Forum, December 2016, https://www.qualityforum.org/Publications/2016/12/Attribution_-_Principles_and_Approaches.aspx.
Attribution is just one of many areas in which NQF partners with
HHS in enhancing and protecting the health and well-being of all
Americans. Quality measurement is essential to a high-functioning
healthcare system, as evidenced in many of the targeted projects that
NQF is being asked to undertake. HHS greatly appreciates the ability to
bring many and diverse stakeholders to the table to help develop the
strongest possible approaches to quality measurement as a key component
of our healthcare system. We look forward to a continued strong
partnership with the National Quality Forum in this ongoing endeavor.
III. Collection of Information Requirements
This document does not impose information collection requirements,
that is, reporting, recordkeeping, or third-party disclosure
requirements. Consequently, there is no need for review by the Office
of Management and Budget under the authority of the Paperwork Reduction
Act of 1995 (44 U.S.C. 3501 et seq.).
IV. Addendum
In this Addendum, we are publishing the NQF Report on 2016
Activities to Congress and the Secretary of the Department of Health
and Human Services.
Dated: August 16, 2017.
Thomas E. Price,
Secretary, Department of Health and Human Services.
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[FR Doc. 2017-17734 Filed 8-21-17; 8:45 am]
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