Secretarial Review and Publication of the National Quality Forum 2018 Activities Report to Congress and the Secretary of the Department of Health and Human Services, 30129-30209 [2019-13626]

Download as PDF Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices Dated: June 20, 2019. Lowell J. Schiller, Principal Associate Commissioner for Policy. [FR Doc. 2019–13561 Filed 6–25–19; 8:45 am] BILLING CODE 4164–01–P DEPARTMENT OF HEALTH AND HUMAN SERVICES [CMS–3365–N] Secretarial Review and Publication of the National Quality Forum 2018 Activities Report to Congress and the Secretary of the Department of Health and Human Services Office of the Secretary of Health and Human Services, HHS. ACTION: Notice. AGENCY: This notice acknowledges the Secretary of the Department of Health and Human Services’ (the Secretary) receipt and review of the National Quality Forum 2018 Annual Activities Report to Congress and the Secretary submitted by the consensus-based entity under contract with the Secretary in accordance with the Social Security Act. The Secretary has reviewed and is publishing the report in the Federal Register together with the Secretary’s comments on the report not later than 6 months after receiving the report in accordance with section 1890(b)(5)(B) of the Social Security Act. FOR FURTHER INFORMATION CONTACT: Sophia Chan, (410) 786–5050. SUPPLEMENTARY INFORMATION: SUMMARY: jbell on DSK3GLQ082PROD with NOTICES I. Background The United States Department of Health and Human Services (HHS) has long recognized that a high functioning health care system that provides higher quality care requires accurate, valid, and reliable measurements of quality and efficiency. The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) (Pub. L. 110–275) added section 1890 of the Social Security Act (the Act), which requires the Secretary to contract with the consensus-based entity (CBE) to perform multiple duties designed to help improve performance measurement. Section 3014 of the Patient Protection and Affordable Care Act (the Affordable Care Act) (Pub. L. 111–148) expanded the duties of the CBE to help in the identification of gaps in available measures and to improve the selection of measures used in health care programs. HHS awarded a competitive contract to the National Quality Forum (NQF) in January 2009 to fulfill the requirements of section 1890 of the Act. A second, VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 multi-year contract was awarded to NQF after an open competition in 2012. A third, multi-year contract was awarded again to NQF after an open competition in 2017. Section 1890(b) of the Act requires the following: Priority Setting Process: Formulation of a National Strategy and Priorities for Health Care Performance Measurement. The CBE must 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-centered 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 across multiple providers, practitioners and settings. Endorsement of Measures: The CBE must 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 are 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: The CBE must provide for the review and, as appropriate, the endorsement of the episode grouper 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; (2) such measures that have not been considered for endorsement by such entity but are PO 00000 Frm 00048 Fmt 4703 Sfmt 4703 30129 used or proposed to be used by the Secretary for the collection or reporting of quality and efficiency measures; and (3) 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 various federal health care quality reporting and quality improvement programs including 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. Transmission of Multi-Stakeholder Input: Not later than February 1 of each year, the CBE must 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 an annual report. The report must describe: • 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 of the CBE’s duties required under its contract with the Secretary; • 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 E:\FR\FM\26JNN1.SGM 26JNN1 30130 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices jbell on DSK3GLQ082PROD with NOTICES such measures 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. Section 50206(c)(1) of the Bipartisan Budget Act of 2018 (Pub. L. 115–123) amended section 1890(b)(5)(A) of the Act to require the report to include the following each year: (1) An itemization of financial information for the previous fiscal year, including annual revenues of the entity, annual expenses of the entity, and a breakdown of the amount awarded per contracted task order and the specific projects funded in each task order assigned to the entity; and (2) any updates or modifications to internal policies and procedures as they relate to duties of the CBE, including, specifically identifying any modifications to the disclosure of interests and conflicts of interests for committees, work groups, task forces, and advisory panels of the entity, and information on external stakeholder participation in the duties of the entity. The statutory requirements for the CBE to annually report to the 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 of 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 2018 activities to the Secretary on March 1, 2019. Comments from the Secretary on the report are presented in section II of this notice, and the National Quality Forum 2018 Activities Report to Congress and the Secretary of the Department of Health and Human Services is provided, as submitted to HHS, in the addendum to this Federal Register notice in section III. II. Secretarial Comments on the National Quality Forum 2018 Activities Report to Congress and the Secretary of the Department of Health and Human Services Once again, we thank the 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 VerDate Sep<11>2014 20:18 Jun 25, 2019 Jkt 247001 for use across varied providers, settings of care, and health conditions, NQF reports that in 2018 it updated its measure portfolio by reviewing and endorsing or re-endorsing 38 measures and removing 40 measures.1 Endorsed measures address a wide range of health care topics to promote value-based transformation of our health care system, and other HHS priorities, 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 maintaining measures endorsement, NQF also worked to remove measures from the portfolio for a variety of reasons, such as, measures no longer meeting endorsement criteria; harmonization between similar measures; replacement of outdated measures with improved measures; and lack of continued need for measures where providers consistently perform at the highest level.2 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. Measure set refinements also align with HHS initiatives, such as the Meaningful Measures Initiative at Centers for Medicare and Medicaid Services (CMS). CMS is working to identify the highest priorities for quality measurement and improvement and promote patientcentered, outcome based measures that are meaningful to patients and clinicians. NQF also undertook and continued a number of targeted projects dealing with difficult quality measurement issues. In particular, NQF has worked to help HHS address the unique challenges faced by rural communities. Nearly one in five Americans reside in rural communities and statistically, residents of rural communities tend to have worse health status than those living in urban areas.3 HHS recognizes the unique challenges facing rural America, and with the support of partners like NQF, we are taking action to improve access and quality for healthcare providers 1 National Quality Forum (March 1, 2019) Report of 2018 Activities to Congress and the Secretary of the Department of Health and Human Services, p. 6 (https://www.qualityforum.org/Publications/2019/ 03/2018_Annual_Report_for_Congress.aspx, accessed 4/10/2019). 2 National Quality Forum, op. cit. p. 18. 3 Centers for Disease Control and Prevention (January 2017) Rural Americans at higher risk of death from five leading causes. (https:// www.cdc.gov/media/releases/2017/p0112-ruraldeath-risk.html, accessed 4/10/2019). PO 00000 Frm 00049 Fmt 4703 Sfmt 4703 serving rural patients. One of the biggest challenges rural Americans face is access to affordable quality health care.4 5 6 Our reforms in the area of rural health are part of our overall strategy to update our programs and improve access to high quality services. In 2018, recognizing the lack of representation from rural stakeholders in the pre-rulemaking process, HHS tasked NQF to establish a Measures Application Partnership (MAP) Rural Health Workgroup. The membership of the Workgroup, comprised of 18 organizational members, seven subject matter experts, and 3 federal liaisons, reflects the diversity of rural providers and residents, and allows for input from those most affected and most knowledgeable about rural measurement challenges and potential solutions.7 With this valuable input from our partners and stakeholders, HHS can continue to improve health care in rural America. The Workgroup identified a core set of the best available, ‘‘rural-relevant’’ measures to address the needs of the rural population and released a report providing recommendations regarding alignment and coordination of measurement efforts across both public and private programs, care settings, specialties, and sectors (both public and private).8 NQF presented the Workgroup’s finding on Capitol Hill to share this valuable work with members of the Congress.9 The Workgroup also provided guidance for the Measures Application Partnership to ensure that the Measures Under Consideration (MUC) for use in CMS programs address the needs and challenges of rural 4 Douthit, N., S. Kiv, T. Dwolatzky, and S. Biswas (June 2015). Exposing some important barriers to health care access in the rural USA. Public Health. 129(6): 611–620. 5 D. Williams, Jr., and M. Holmes (January 2018) Rural Health Care Costs: Are They Higher and Why Might They Differ from Urban Health Care Cost? North Carolina Medical Journal. 79(1): 51–55. 6 J. Bhatt and P. Bathija (September 2018) Ensuring Access to Quality Health Care in Vulnerable Communities. Academic Medicine. 93(9): 1271–1275. 7 National Quality Forum (August 31, 2018). A Core Set of Rural-Relevant Measures and Measuring the Improving Access to Care: 2018 Recommendations from the MAP Rural Health Workgroup: Final Report, p. 32 (https:// www.qualityforum.org/Publications/2018/08/MAP_ Rural_Health_Final_Report_-_2018.aspx, accessed 4/10/2019). 8 National Quality Forum. 2018, op. cit. 9 National Quality Forum (September 17, 2018) NQF Releases Report to Improve Access and Health Needs of Rural Communities (https:// www.qualityforum.org/News_And_Resources/Press_ Releases/2018/NQF_Releases_Report_to_Improve_ Access_and_Health_Needs_of_Rural_ Communities.aspx, accessed 4/10/2018). E:\FR\FM\26JNN1.SGM 26JNN1 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices providers and residents.10 HHS is committed to evaluating our measurement practices and looking at them through a rural lens to ensure rural providers greater flexibility and less regulatory burden. Additionally, CMS and NQF have worked together to address the low casevolume challenge as it pertains to healthcare performance measurement of rural providers. Low case-volume presents a significant measurement challenge for many rural providers.11 Rural areas often are sparsely populated, which can affect the number of patients eligible for inclusion in healthcare performance measures, particularly condition- or procedure-specific measures. Other challenges faced by rural residents, such as distance to care or lack of transportation, can also lead to low case-volume in measurement. To develop recommendations to address the low case-volume challenge for rural providers, NQF convened a five-member Technical Expert Panel (TEP) comprised of statistical experts and measure methodologists.12 The TEP released a jbell on DSK3GLQ082PROD with NOTICES 10 National Quality Forum (December 12, 2018). MAP Clinician Workgroup In-Person Meeting presentation slides #38–43. (https:// www.qualityforum.org/ProjectMaterials.aspx? projectID=75361, accessed 4/10/2019). 11 Quality of Care in Rural Hospitals. (January 2019) Rural Health Research RECAP. Rural Health Research Gateway (https://ruralhealth.und.edu/ assets/2645-9942/quality-of-care-in-rural-hospitalsrecap.pdf, accessed 4/10/2019). 12 National Quality Forum. (October 31, 2018) MAP Rural Health Technical Expert Panel Conference Call #1 presentation slides (https:// www.qualityforum.org/ProjectMaterials.aspx? projectID=85919, accessed 4/10/2019). VerDate Sep<11>2014 20:18 Jun 25, 2019 Jkt 247001 report providing recommendations to CMS on how to best address the low case-volume challenge by incorporating new statistical methods into measures specifications.13 Going forward, CMS will continue to work with NQF to strengthen the diversity of representation of the MAP Rural Health Workgroup. In particular, CMS is taking into account the largely rural nature of Tribal and Indian Health Service (IHS) health programs, their unique, cultural, funding, and legal status, and their specific challenges in participating in initiatives, which rely heavily on the use of clinical quality measures. For future NQF calls for nomination for the MAP Rural Health Workgroup, CMS will encourage NQF to sit representatives of Tribal Nations, Tribal health programs, or Tribal organizations. CMS will also reach out to IHS for recommendations of individuals with expertise in clinical quality measures and knowledge in health outcomes and barriers to care experienced by rural-dwelling Native Americans and nominate them as Workgroup members, and IHS staff with said expertise and experience as Federal Liaisons for the Workgroup. In addition, CMS will ask NQF to reach out to Tribal Nations, Tribal Health programs, and Tribal organizations for input during the public comment periods for project deliverables. 13 National Quality Forum (April 2019). MAP Rural Health Technical Expert Panel Final Report— 2019 (https://www.qualityforum.org/Publications/ 2019/04/MAP_Rural_Health_Technical_Expert_ Panel_Final_Report_-_2019.aspx, accessed 4/10/ 2019). PO 00000 Frm 00050 Fmt 4703 Sfmt 4703 30131 Addressing the needs of rural health communities is just one of many areas in which NQF partners with HHS in enhancing and protecting the health and well-being of all Americans. Meaningful quality measurement is essential to healthcare delivery reform, 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 to health care delivery system reform. We appreciate the strong partnership with the NQF 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 2018 Activities to Congress and the Secretary of the Department of Health and Human Services, as submitted to HHS. Dated: June 7, 2019. Alex M. Azar II, Secretary, Department of Health and Human Services. BILLING CODE 4120–1–P E:\FR\FM\26JNN1.SGM 26JNN1 30132 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices NQF Report of 2018 Activities to Congress and the Secretary of the Department of Health and Human Services March 1, 2019 This report was funded by the U.S. Department of Health and Human Services under contract number VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00051 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.021</GPH> jbell on DSK3GLQ082PROD with NOTICES HHSM-500-2017-000601 Task Order HHSM-500-T0002. 30133 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices Contents 1. ExecutiveSummary .................................................................................................................... 4 II. NQF Funding and Operations ..................................................................................................... 8 Ill. Recommendations on the National Quality Strategy and Priorities ............................................ 9 IV. Quality and Efficiency Measurement Initiatives (Performance Measurement) ......................... 13 10 Priority Initiative to Improve Rural Healthcare Cross-Cutting Projects to Improve the Measurement Process 13 NQF Scientific Methods Panel 17 Measure Endorsement and Maintenance Accomplishments ................... v. h ..................................... l8 Stakeholder Recomi'M!ndatlons on Quality and Effidencv Measures and Natlo1ull Priorities .... 27 Measure Applications Partnership 27 2018 Pre-Rule making 28 MAP Clinician Workgroup ................................................................................................................ 28 MAP Hospital Workgroup ................................................................................................................. 29 MAP PAC/LTC Workgroup ............................................................,. ................................................... 30 2018 Measurement Guidance for Medicaid and CHIP ..................................................................... 31 VI. Gaps on Endorsed Quality and Efficiency Measures Across HHS Programs ................................ 33 Gaps Identified in Completed Projects 2018 .................................................................................... 33 Measure Applications Partnership: Identifying and Filling Measure Gaps ...................................... 33 VII, Gaps in Evidence and Targeted Resean:h Needs ........................................................................ 33 Popuiation·6ased Trauma Healthcare Systems Readiness .................................... '"······ ............................ ,................................. 35 Chief Complaint Based 35 Ambulatory Care Patient 36 Common Formats for Patient Safety ................................................................................................. 37 VIII. Coordination with Measurement Initiatives by Other Payers ........... , ......... ,.., ...................... 38 Exploration of Approach to Measure Feedback .............................................................................. 38 Core Quality Measures Collaborative- Private and Public Alignment 39 IX. Condusion ............................................................................................................................... 40 X. References ............................................................................................................................... 43 VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00052 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.022</GPH> jbell on DSK3GLQ082PROD with NOTICES Appendix A: NQF Funding and Operatiom; ......................................................................................... 50 30134 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices Appendix B: Multlstakeholder Group Rosters: Committee, Workgroups, Task Forces, and Advisory Panels ................................................................................................................................................ 51 Appendix t: Scientific Methodll Panel Roster ..................................................................................... 60 Appendix D: 2018 Activities Performed Under Contract with HHS ...................................................... 61 Appendix E: MAP Measure Selection Criteria .................................................................................. .,. 64 Appendix F: MAP Structure, Members, Criteria for Service, and Rosters ............................................ 67 Appendix G: Federal Public Reporting and Performance-Based Payment Programs Considered by MAP .................................................................................................................................................. 70 Appendix H: Medicare Measure Gaps Identified by NQF's Measure Applications: Partnership ............ 71 Appendix 1: Medicaid Measura Gaps Identified by NQF's Medicaid Workgroups ................................ 73 VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00053 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.023</GPH> jbell on DSK3GLQ082PROD with NOTICES Appendix J: Measure Gaps Identified by NQF Measure Portfolio ........................................................ 74 30135 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices Executive Summary I. tra1~~i!·ion to healthcare system "'"'f"'''"''""''"' measures. Performance m•'"'""" {VBP} to lower the cost and improve the quality of healthcare in the United States. Measurement is a that helps to identify opportunities improvement, understand success, and promote transparency to allow Americans become active and empowered healthcare consumers who can seek safe and effective care. Measmement enjoys strong, bipartisan support as well as support across both the public and private sectors. This unified commitment and continued investment in performance measurement ensures all stakeholders have a shared vision of high-quality, cost-effective care, promotes alignment around healthcare system improvement priorities, and reduces unnecessary administrative burden on providers. The National Quality Forum (NQF) an independent organization that brings together public· and private·sector stakeholders from across the healthcare system to determine the high· value measures that can best drive improvement in nation's health and healthcare. NQF private-sector on quality measures use federal programs, advances of performance measurement,. and identifies and provides direction to address critical called gaps, where quality are underdeveloped or n<">r><"xi~M·nt~ report, NQf: Report Congress and the Secretary Department of Health and Human Services, highlights and summarizes the work that NQF performed between January 1 and December 31, 2018 under contract with the U.S. Department of Health and Human Services (HHS) following six areas: • • Recommendations on the National Quality Strategy and Priorities; Quality and Efficiency Measurement Initiatives (Performance Measures); • • Stakeholder Recommendations on and Efficiency Meas.unc~s; Gaps. on Endorsed Quality and Efficiency Measures across HHS Programs; • • Gaps in Evidence and Targeted Research Needs; and Coordination with Measurement Initiatives by Other Payers, agreement across the public and private sectors about what to measure and healthcare. The Medicare Improvements for Patients and Providers Act (MIPPA) {Pl110<275) established the responsibilities of the consensus-based entity section of the Social Act. The 2010 Patient Protection and Affordable Care Act !Act\) !PL 111-148} modified and added to the consensus·based entity's responsibilities. The American Taxpayer Relief Act of 2012 (Pl112-240) extended funding under the MIPPA statute to the consensus-based entity through fiscal year 2013. The Protecting Access to Medicare Act of 2014 {PL113-93) extended funding under the M!PPA and ACA statutes to the consensus-based entity through March 31, 2015. Section 207 of the Medicare Access and Children's. Health Insurance Program {CHIP) Reauthorization Act of 2015 (MACRAj (Pl114-10) extended funding under section of the Social Security Act for quality measure endorsement, input, and selection for fiscal years 2015 through Sectio11 50206 of the Bipartisan Budget Act of 2018 VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00054 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.024</GPH> jbell on DSK3GLQ082PROD with NOTICES 4 30136 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices extended funding for federal qual!ty efforts for two years (October 2017- September 2019) among the designation as CEE, is charged annually on lts work to Congress and the HHS Secretary. As amended by the above laws, the Social Security Act (the Act)-specifically section 1890(b)(5)(A)mandates that the entity report to Congress and the Secretary of the Department of Health and Human Services {HHSI no later than March lstofeach year. The report must include descriptions of: • • how NQF has implemented quality and efficiency measurement initiatives under the Act and coordinated these initiatives with those implemented by other payers; NQF's recommendations with respect tc rm integrated national strategy and priorities for h!!!olthcr:ue performance measurement • • all applicable settings,' NQPs performance of the duties required under its contract with HHS (Appendix A); within priority areas identified by the Secretary under HHS' notional strategy, and where quality and efficiency measures are unalf(J//able or inadequate to identify or address such gaps," • areas which evidence is to support endorsement of measures priority areas identified by the National Quality Strategy, and where targeted research may address such gaps; • matters related to convening multistakeholder groups to provide input on: the selection of certain quality and efticiMcy measures, and b} national priorities for improvement in population !Jealth and in the delivery of heoltilwre services for consideration under the Notional Quality • an itemization of financial information for the fiscal year ending September 30 of the preceding year, including: {I) annual revenues of the entity {including any government funding, privat~& sector contributions, gwnts, membership revenues, cmd investment (II} annual expenses of the entity benefits paid, salaries or other compensation, fundraising expenses, and overhead costs}; and (Ill) a breakdown of the amount awarded per contracted task order and the specific projects funded in each task to the entity; and updates or modifications of internal policies and procedures of the relate to the duties of the entity under this section, including: W specifically identifying any modifications to the disclosure of interests and conflicts of interests for committees, work groups, task forces, information on external stakeholder participation in and advisory panels of the entitv; ond the duties of the entity under this section {including complete rosters for aJJ committees, work groups, task forces, and advisory panelsft.mded thr011gh government contracts, descriptions of relevant interests ond any conflicts of interest for members of of/ committees, work groups, task forces, and advisory panels,. and the total percentage by health care sector of oil convened committees, work grm1ps, task forces, and advisory panels. jbell on DSK3GLQ082PROD with NOTICES • VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00055 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.025</GPH> Stmteg;~·.' Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices contract HHS 30137 2018 are referenced throughout this report, included in ~2ill:~~.lmmedfately following is a summary of NQF's work six aforementioned are discussed Recommendations on the National Priorities comrened public and private sector priorities reflected provide input into the National Quality Strategy (NQS) that In 201fl, NQF released continued to support these priorities through work to improve the health of Americans living in rural areas. Healthcare performance measurement may be an underutilized tool to improve rural health. While many rural hospitals are required to participate a variety of quality improvement programs implemented by CMS or face reductions in payment {e.g., the Hospital Inpatient Quality Reporting Program!, criticill access hospitals many rural clinicians who serve in these programs on a voluntary federally qualified health centers or minimum case load or billing thresholds (MIPS). healthcare. Finally, For example, they may assess offered by many rural nrr)Vli1Pr"L on conditions or procedure> for which many rural providers do not have enough patients to achieve reliable and valid measure results. To address these issues, in 2018, NQF's multistakeholder MAP Rural Health Workgroup identified a core set measures for the hospital and ambulatory settings. Many of the 20 measures in this core set are cross,cutting, resistant to low case,volume, and address conditions or services that are relevant within healthcare settings, and therefore should be applicable to a majority of rural patients and providers. Quality and Efficiency Measurement Initiatives (Performance,.,,.,,..,......,.. , Evidence·based and scientifically sound measures are essential to advancing national healthcare improvement priorities and supporting the transition to value·based purchasing. NQF· have confidence that NQF-endorsed measures ac<:epta!lili1cy usability, and feasibility-and can discern provider performance. 2018, NQF endorsed 38 measures and removed 40 from its portfolio, across 28 endorsement projects addressing 14 topic areas. NQF endorsed measures focused on driving key improvements to the healthcare system. NQF aims to identify measures that can promote patient-centered care (e~g., person· and family·centered care, care coordination, and palliative and end"C!Hife care), improve the delivery of care for prevalent conditions jbell on DSK3GLQ082PROD with NOTICES VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00056 Fmt 4703 Sfmt 4725 and cancer), or E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.026</GPH> infectious disease; eye care and ear, nose, and 30138 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices promote quality improvement cross-cutting areas {e.g., patient safety, cost and resource use, health wen-tc•<lnr•"' and all-cause and readmissions). issue project improve to account for the influence a person 1s socioeconomic status or other soda! risk factors can have on his or health care outcomes and how measurement should account for this NQF also implemented key improll€ments to the measure endorsement process, including creation of the Scientific Methods Panel, charged with assisting in the review of complex measures and providing guidance on NQF on methodological issues, including those related to measure testing, risk adjustment 1 and measurement approaches. Stakeholder Recommendations on Quality and Efficiency Measures The Measure Applications Partnership (MAP) is a public-private partnership con\!€ ned by NQF that input to HHS on the selection and efficiency measures pay-for-performance and qualfty reporting programs. Over 135 representatives from 90 private-sector stakeholder organizations and se\f€n federal agendes participate in MAP. This varied representation promotes balanced and attentive input on the selection performance measures ln quality reporting being cognizant of the burden measurement can place on providers. MAP promotes alignment, the use of the same measures across federal programs and the and private sectors as one strategy to minimize the burden of measurement. Using the same measures allows providers to on key quality improvement areas, eases the burden of data collection on clinicians and facilities, and reduces the confusion caused by similar, redundant measures, For the 2017-2018 pre-rulemaking process, MAP convened three care setting-specific workgroupsClinician, Hospital, and Post-Acute Care/Long-Term Care use review proposed mea&ures for Medicare programs. MAP reviewed 35 measures-recommending 34 either program for continued a federal review on Endorsed strives to promote measures that are meaningful to patients and target important areas for improvement in the healthcare system. A crucial part of NQF'; work is identifying measure gaps, areas in which evidence-based, scientifically sound measures are too few or do not exist. identifying these gap areas allow stakeholders such as measure developers and po!icymakers to better understand critical measurement needs. The gaps identified in 2018 span conditions, settings, and issues, from care for costly and prevalent diseases to access to care to patient experience, and more. NQF continued to highlight the need for more outcome measures, especially ones that are patient-reported. Other address behavioral health and substance abuse as well as r.--.."n-•r.n gap areas include more measures VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00057 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.027</GPH> jbell on DSK3GLQ082PROD with NOTICES 7 30139 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices health~conditions measures to address social determinants a person's environment that affect and qLiality of life. to develop approaches to leverage new ways to improve health and heelthcare for the nation. These projects develop conceptual models for for a topic area and for describing organizing ideas that are important to measurement take place (Le,, whose performance should be measured, care settings where measurement is needed, when measurement should occur, or which individuals should be included in measurement), NQF's foundational work in these important areas underpins future efforts to improve quality through measurement and ensure safer, patient-centered, cost-effective care that reflects science and evidence. NQF completed one project ln 2018 to measure concepts to improve care in ambulatory care settings. NQF and gaps trauma eare, new projects to identify areas quality and safety of measure development assess the readiness of hospitals, healthcare systems, and communities to respond to and recover from disasters and health emergencies, and develop a strategic plan for chief complaints can be addressed through quality measurement In support structured reporting worl:., NQF continued its safety events in hospitals and settings. Coordination with Measurement Initiatives by Other Payers 2018, NQF began two projects to promote coordination acros5 payers. The first project aims to develop a process to collect feedback from payers using NQF-endorsed measures, as welt as other stakeholders, about measures after they are implemented. Stronger and more standardized feedback would allow a better understanding of how a measure performs when in use, and the possible issues or risks that may be associated with the measure's the intended effect of improving quality implementatior~, such as whether a measure is having care and health outcomes or evaluating if measure is causing unintended consequences. Adding to NQF's efforts to encourage the use of more meaningful measures and reduce measure burden NQF in 2018 after several years of providing technical assistance, The and Plans (AHIP), also involves the Centers for Medicare & Medicaid Services (CMS), public-sector payers to reach performance measures. to maintain the core sets, identify priority areas for new core sets, refine the group's measure selection criteria, and provide technical support to the CQMC. II. NQF Funding and Operations Section1890 (b) (5) (A) of the Social Security Act is amended by adding the following financial and operations information in the Annual Report to Congress and the SecretaryAnnual revenues of the entity (including any government funding, private sector contributions, grants, membership revenues; and investment revenue) VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00058 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.028</GPH> jbell on DSK3GLQ082PROD with NOTICES 8 30140 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices Annualexpl;:rtses of the entity (including grants paid, benefits paid, salaries and other compensatk:ms, fundroising and overhead costs); and a breakdown of the amotmt awarded per contracted task order and the specific projects funded in each task order assigned to the en tit}' Any updates or modifications of intemal policies and procedures they r<:late to the duties of the entity under this section., including (i) specifically identifying any modifications to the disclosure of interest and conflicts of interests for committees, work groups, task forces, and advisory panels of the entity; and {ii} information on external stakeholder participation in the duties of the entity under this section (including complete rosters for all committees, wotk groups, task forces, and advisory panels funded through government contracts, descriptions of relevant inurests ond any conflicts of intuests for members of oil committees, work groups, task forces and advisory panels, and total percentage by health sector of all convened committees, task forces, ond advisor}' panels, Cn!rmress reauthorized funds the Bipar·tisan Budget Act a 2018. The Department of Health to the (NQF) to as independent, noMor"profit, membershlp.based organization that brings ""'"lt•Mr'""' recommend quality measures better care. The Bipar·tisan Budget Act of 2018 amended the requirements of this annual report to include, in addition to the previous requirements set forth, new contratt, financial, and operational information related to the CBE. Federally funded contracts awarded under the CBE authority were 2018. Of this amount, FV were funded through the Trust Fund. NQF's revenues for FY 2018 were $20.6 million, including federal funds authorized under SSA 1890(d), private sector c011tributions, NQF's expenses for FY 2018 were million. These grants and benefits paid, salaries and other compensations, fundraising expenses, and A breakdown of the contract is available in updates or modifications to disclosure of interest and conflict of interest committees. and workgroups Ill. has made Rosters of a total percentage breakdown by healthcare sector) funded Recommendations on the National Quality Strategy and Priorities Section 1890(b)(1) of the Social Security Act (the Act), mandates that the consensus-based entity (entity) shall us)itltllesize evidence and convene ke}' stakeholders to moke recommendations . .. on an integrated national strategy and priorities for health care performance measurement in all applicable settings. In making such recommendations, the entity shall ensure that priority is given to measures: that address the health core provided to patients with prevalent, high·cost chronic diseases; with the greatest that may potential for improving the quality, efficiency, and potient-c:enteredness of health care; and implemented rapidly due to existing evidence, standards of core, or other reasons.* addition, the VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00059 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.029</GPH> jbell on DSK3GLQ082PROD with NOTICES 9 30141 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices entity is to "take into account measures that: may assist consumers and patients in making informed address health disparities across groups and and the a patient receives, including services furnished by nmltiple health care providers or practitioners and across multiple setti11gs, continuum request of HHS, the NQF-corwened National Priorities Partnership (NPP) provided input that shape initial version o.f the National QuaHty Strategy (NQS) that HHS Ma t"Ch NQS set forth a comprehensive roadmap for achieving better, more affordable care, as well as better health. HHS accentuated the word "national" in its title, emphasizing that healthcare stakeholders across the country, both public and private, all play a role in making the NQS a success. Annually, NQF continue~ to promote the NQS by endorsing measures linked to its priorities and convening diverse stakeholder groups to reach consensus on key strategies for performance 2018, NQF began work to address healthcare quality measurement and quality improvement measurement settings. Rural Americans face documented healthcare, and rural providers have historically been left out of quality measurement initiatives, NQF explored ways areas and to identify leverage quality measurement ways overcome uniqLJe challenges Priority Initiative to Improve Rural Healthcare Rural areas span across 97 percent of the with approximately 60 million individuals residing these areas."1 Of these, 47 million are adults aged 18 years and older. Compared to the urban and suburban regions in the rural communities have higher proportions of elderly residents, higher rates of poverty, greater burden of chronic diseases je_g,, diabetes, hypertension and chronic obstructive pulmonary disease), and limited access to the healthcare delivery system. For example, while 60 percent of trauma deaths in the U,S. occur areas, only 24 percent of rural residents are able to access a trauma center compared to 85 percent of urban and suburban residents, highlighting the severity of the problem of insufficient access to healthcare providers in face many challenges in data and implementing care improvement efforts HH'-'·'''""i"ri project, NQF convened challenges quality measurement add res~ the needs of their populations, In a 2015 mu!tistakeholder Rural Health Committee rural providers. quality Committee noted that demands (e,g., direct patient care, business and operational responsibilities) cornn•~te attention of providers who serve in the time and rural hospitals and clinical practices-particularly those in geographically isolated areas, Thus, these providers may have limited time, staff, and finances available for improvement activities, In addition, some rural areas may lack information technology (IT) capabilities altogether and/or IT professionals who can leverage those capabiilties for quality measurement and improvement efforts, The heterogeneity of rural areas, such as variations geography, population density, availability of healthcare services, and numbers of vulnerable residents (e.g., those with or other social disadvantages, those ln poor health, etc.), has particular implications for healthcare performance VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00060 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.030</GPH> jbell on DSK3GLQ082PROD with NOTICES 10 30142 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices measurement. These include applicability of many healthcare performance measures and, modifications in the approach particular performance been referred to as the low case-volume Rural Health Committee made recommendation to participation in CMSquality measurement and quality improvement programs mandatory for all rural providers, but to do so via a phased approach and in a way that explicitly addresses the low case-volume challenge. The Committee noted that nonpartidpation federal quality programs may affect the ability of these providers to identify and address opportunities for improvement, as welf as demonstrate how they perform compared to their nonrural counterparts, Committee noted that "'rl'rliti,nn;;>l work was needed to address However, challenges rural providers face and unique measurement transition to reporting measures. recommendations include: • developing rural-relevant measures (e.g., to address topics such as patient hand-offs and • aligning measurement efforts • • • considering rural-specific challenges during the measure-selection process; creating a rural health workgroup to advise the Measure Applications Partnership addressing the design and implementation of pay-for-performance programs. transitions, add res& the low case-volume challenge, and include appropriate risk adJustment); measures, data collection efforts, and informational resources}; and To address these recommendations NQF, with funding from HHS, convened the MAP Rural Health Workgroup. In 2018, the Workgroup released a report identifying a core set of measures that can be used for hospitals and for ambcilatory settings such as hospital outpatient departments and clinician offices or clinks. The Workgroup recommended 20 measures for the core set: hospital setting and 11 for the ambulatory setting. In the the measures recommended by the Workgroup set align with the recommendations made by NQF's Rural example, the number of proposed measures aligns with the recommended range The majority of the recommended measures tnP•rPtnrP should be applicable to majority includes process and outcome measures, set align with those used cross-cutting Committee. For 10-20 measures per resistant rural patients and providers, low case-volume the core set measures based on patient report. Finally, measures other federal quality programs. To determine criteria for selecting measures for the core set, the Rural Health Workgroup first considered the guiding principles for measure selection that were developed by the 2015 Rural Health Committee. Building on those principles as well as on members' experience and expertise, the \hf,~rvo""'" developed a set of measure selection criteria. The Workgroup selecting measures that are NQF-endorsed, cross·cutting, resistant to low case-volume, and address transitions in VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00061 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.031</GPH> jbell on DSK3GLQ082PROD with NOTICES 11 30143 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices care. The latter is particularly important as many rural providers do not provide specialized care for patients, and transfers are addressed the Wr;rktlrrHm s.~rmncnen provided by the Inclusion conditions or servfces that are particularly relevant to rural populations such as mental health, substance abuse, medication diabetes, hypertension, pulmonary disease (COPD), hospital readmissions, and perinatal and pediatric conditions and services. Additionally, the MAP Rural Health Workgroup also provided recommendations on access to care from rural perspective, a topic that arose multiple occa&ions as members deliberated on the core set rural·relevant measures and discussed gap areas in measurement The Workgroup identified three key elements of access from the rural perspective; availability, accessibility, and affordabi!ity. The Workgroup noted the multifaceted elements ways to address those these domains and explored challenges and nnh>nti">l of availability, the Workgroup disccJssed n.1ral residents' care and nontraditional care. T~>IP~'""l'llth including specialty care, the ways that could address these challenges. Under the domain of accessibility, the Workgroup focused on language barriers between patients and their families/guardians with their heaithcare providers, limited health information due to inadequate phone or internet connectivity and transportation challenges. Suggestions for addressing accessibility challenges included tele·access to interpreters, continued expansion of remote access technology, and corTirrmncnvpartnerships that assi~t in transportation. Lastly, under the domain of the Workgroup examined how out·of·pocket costs (e.g., deductibles, co·pays, and travel expenses) impact a person's ability to access The lack of financial resources can result in delayed care because patients and families cannot afford the out-of· The Workgn::.up the appropriateness of potential risk adjuster, contimring efforts to preserve the nation's healthcare safety literacy insurance and the continues to build on the recommendations of distance as a increasing extent of a provider's education and credentials. MAP Rural Health Workgroup. NQF organized a briefing on the findings of the report with then ccH:hairs of the U.S. Senate Rural Health Caucus, Senators Heidi Heitkamp (D-ND) and Pat Roberts (R·KSJ, on Tuesday, September 18, 2018. Additionally, NQF began new work in 2018 to advance the use of measurement to improve rural health. NQF re-convened the MAP Rural Health Workgroup to provide input into the annual pre-rulemaking process, and seated a Technical Expert Panel (TEP) to provide feedback and recommendations to address the low case-volume challenge faced by many rural providers. A report on the findings of the TEP is expected in April 2019. VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00062 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.032</GPH> jbell on DSK3GLQ082PROD with NOTICES 12 30144 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices IV. Quality and Effideney Measurement Initiatives (Performance Measurement) of the Social Security Act reqvires the consensws-based (CBE) to endorse Section 1890(b){2) and stornd'artiize1d healthcare performance TIJe lilndorsement process flliiSt consider whlilthlilr measures ore evidence-based, reliable, vafkl, verifiable, relevant to enhanced health outcomes, actionable at the caregiver level, feasible for collecting and reporting, responsive voriations in patient clmmcteristics, and consistent across types of heolthcare providers, In addition, the CBE must establish and implement a process to ensure that measures endorsed are updated (or retired if obsolete) as new evidence developed, Working with multistakeholder committees to build consensus, NQF reviews and endorses healthcare performance measures. Measures help dinidans, hospitals, and other providers understand whether the care they provide their patients fs optimal, and appropriate, and if not, where to focus improvement efforts. The federal government, states, private-sector organizations use NQF-endorsed measures Prrm''"'"'r" Nn,~:.,,,,l""''"" measures serve patients, and their families; and enhance healthcare by ensuring improvement high-quality n.-,rfot'm''""'''""data are available, which comparisons the to benchmark performance. CLJrrently, NQF has a portfolio of 543 NQF·endorsed measures that are used across the healthcare system, Subsets apply to particular settings levels analysis, c:r<>SS·CWI:tll1111! Projects to Improve the Measurement Process NQf undertook two projects to better understand the science of performance measurement These projects aimed to provide greater insights to measure methodology and provide future guidance for NQF's work to endorse performance measures, particular, NQF explored ways to improve attribution models-that is, the methodology through which a patient and his or her healthcare outcomes are assigned to a provider~and examined the ongoing issue of how to account for the influence a person's socioeconomic status or other social risk factors can have on his or her healthcare outcomes. Improving Attribution Models Changing a heal the are system pays on volume of services to one pays value requires understanding of who is accountable a patient's outcomes. However, it is not always clear who is rP<.nnn~!lhl" for a patient's care and as many different providers Attributfon a methodology to assign patients, or episodes of care to a healthcare provider or practitioner. It attempts to determine a patient-provider relationship for the purposes of determining accountability for a person's care. Fair and accurate attribution is essential to the success of value-based purchasing and alternative payment models. 2018, NQf concluded a one-year project to provide guidance on an attribution model design and to provide a foundation lor future multista!<:eholder review of attribution models. This work built on NQf's previous work to define the elements of an attribution modeL This work centered on three main attribution challenges: determining what evidence necessary to demonstrate a provider could VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00063 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.033</GPH> jbell on DSK3GLQ082PROD with NOTICES the outcomes assigned, exploring what testing could be done to show how well an attribution 30145 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices model reflects the actual patient-provider relationship, and understanding how '"~""'"'",.t attribution and unintended consequences As a first developing this anirbr"'"' that provided insights complex patient populations. The scan included papers that highlight private sector and state initiatives as well as articles that incorporate models as part of more general best practices, outcome and cost measurement, and measure alignment Key findings from the scan included: • Information about how attribution models are tested for reliability and validity is limited " The avaHabiHty of data from electronic health records, as well as patient and clinician attestation of relationships could improve attribution models • • and providers attribution longer periods of time and across multiple care settings. supplemented the finding& of representatives from payer organizations, scan with key informant interviews with clinicians, patient advocates. These interviews identify examples of the current realities of attribution and information available to physicians and patients; the discrepancies between current models and how care is delivered; and the potentia! for misattribution to have negative consequences for both patients and providers. NQF convened an Attribution Expert Panel to explore a set of key attributiOil challenges .. identify best practices, and outline key considerations for evaluating attribution models, The Expert Panel developed a set of evaluation criteria to guide future multistakeholder reviews of attribution models, including: " Does the attribution modelallllign accountability to an entity that can meaningfully influenca relationship between a patient and provider and that the provider control over the patient's can include results, why a given set consequences. • liow has the model been tested? Given the number and variation of attribution methodologies that can be employed and how the methodology selected can influence results, attribution models must be tested to ensure they are valid and to understand which patients would be covered under different attribution rules. • What data were used to support the attribution model? Data play an essential role in the implementation of an attribution model, Available data sources and data quality should be considered when designing and selecting an attribution modeL VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00064 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.034</GPH> jbell on DSK3GLQ082PROD with NOTICES 14 30146 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices • Does the model align with the context of its use1 Attribution models be designed and the specific program context for which they are intended. They should take into the program goal, whether the program ls mandatory used • payment voluntary, accountability and the intended '""'""''"'Change. Have potential unintended consequences ofthe model been explored, and have negative consequences been mitigated? The attribution model selected will drive consequences, both Intended and unintended, Improperly designed attribution models carry :a risk of negative unintended consequences to patients. Attribution models should not diminish access to care or detract from the patient-centeredness of care., such as interfering with patient choice or preventing patients from receiving care they need. • Is the model transparent to all stakeholders? The detail5. of attribution model algorithmo all affected parties, making to understand the currently are not always available results of the model and for providers to improve their performance. Insufficient transparency also prevents patients from them from being empowered who held accountable lor and can prevent coin~•,mers improving attribution models lays the groundwork to address throughout NQF work. Currently, NQF processes exist to build on current attribution not explicitly address attribution. However, to allow multistakeholder of attribution models, such as including attribution as a consideration in the Consensus Development Process (CDP) or MAP process. Social Risk Trial Public- and private-sector payers are increasingly using value-based purchasing to reduce healthcare spending while improving quality by tying provider payments to performance on cost and quality measures. Public· and private·Sector payers also are increasingly using outcome measures as the ,.,,.,.f,~'C''Y\'•"''"' metrics in value-based purchasing programs. However, healthcare quality of solely be influenced by factors assigned patients' health risk to ensure performance measures make fair conclusions about provider quality, Risk adjustment (also known as case-mix adJustment) refers to statistical account for patient-related factors when computing performance measure scores. adjusting outcome measures to account for differences patient health status and clinical factors (e.g., comorbidities, severity of illness} that are present at the start of care is widely accepted. However, there is a growing evidence base that a person's social risk factors (i.e., socioeconomic ami demographic factors) can also affect health outcomes, 1 Previous NQF policy did not allow for measure developers to include social risk factors in the risk-adjustment models of measures being submitted for NQF review endorsement. This policy was risk~adjustment because of concerns that models of endorsed measures factors mask disparities or create lower standards of care VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00065 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.035</GPH> jbell on DSK3GLQ082PROD with NOTICES 15 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices people with social risk factors~ 30147 However, the increased use of performance measures for publk payment to that and NQF concluded a self-funded two·year trial period during whkh measure developers were explore the impact of and could include results of factors in the risk-adjustment models of measures submitted for endorsement review if there were a conceptual basis and empirical evidence to support doing so_ NQf's work, as well as recent and the ~'-'='-""-'~'"- reports from the factors affect their health and healthcare. The trial period highlighted challenges to adjusting measures for soda I risk factors. First, the trial reflect safety-net providers and could worsen disparities by threatening access to risk factors had variable impacts on performance scores, reaffirming the Expert Panel's guidance that each measure must be assessed individually to determine if there is an empirical basis lor social !actor adjustment In July NQF issued a report of its from the trial, highlighting key conclusions and areas where further study may be needed. NQF, with funding from HHS, will build the findings of the initial two.year trial that ended in April 2017. NQF fs implementing the extended trial as part of the COP, and decisions about whether or not a me•nSI.He l$ appropriately adjUSted built upon the lessons of the first to improve the process for the new trial period, NQF included updated information for measure developers and stewards as part of the measure submission form, measure testing attachment, and measure developer guidebook, NQF will use one of its monthly measure developer webinars to provide developers and stewards an update on the new soda! risk triaL examine unresolved issues from the initial trial period to advance the science of risk jbell on DSK3GLQ082PROD with NOTICES .ond explore the challenges VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00066 related to including Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM factors in risk- 26JNN1 EN26JN19.036</GPH> trial period 30148 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices NQF Scientific Methods Panel on five criteria for evaluating measures for endorsement: Importance to Measure and Report, Feasibility, Usability and Use, Sci,entific Acceptability Acceptability Measure PrrmFrtl••<: Related and Competing """m"""""''' hF;3Itl,carl'!: however, during and consistency of evaluation of the re!iabifity and validity of a performance measure due to the increasing sophistication of methodologies involved. To address these issues, NQF created the Scientific Methods Panel to assist in conducting methodological reviews of submitted measures. The Scientific Methods Panel has a twopart charge: 1) Conduct evaluation of complex measures for the criterion of Scientific Acceptability, with a focus on reliability and validity analyses and results; and 2) Serve methodologic issues, including those related to NQF on measure testing, risk approaches. reviewed measure for review. NQF staff conduct an initial evaluation for the standing committee expertise to adequately review and rate other measures. This particularly for members who may scientific merits of a measure. Previously, the complexity of hinder full engagement of standing committee measures and the evaluation methodology members, particularly those less familiar with measure development, statistics, or psychometrics. NQF standing committees are multistakeholder by design and consist of members with varying expertise such as practicing dlnidans, consumers and patients, purchasers, and policy experts. Shifting the ~d.,.ntifir· methodological review of measures to this Panel and NQ~ staff allows for greater engagement and participation, particularly by consumers, patients, and purchasers on committees. Additionally, the Scientific Methods Panel provides guidance that informs Measurement continues to of innovative data measures and measurement "'"'"m'""''"'~ the Sdentiflc M••tht~rl" ongoing advisory capacity to NQF on m<!th·oclolc!glc measurement approaches. Current State of the NQF Measure Portfolio NQF's measure portfolio contains measures across a variety of clinical and cross-cutting topic areas. Forty-four percent of the measures in NQF's portfolio are outcome measures. NQF's multistakeholder has defined complex measures as outcome measures (Including intermediate {e.g., patienHeported cost/resource ~JSe measures, and ,.,_,.,.,,,..,.r,,., VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00067 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.037</GPH> jbell on DSK3GLQ082PROD with NOTICES 17 30149 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices committel\'s-which include patients, consumers, providers, payers, and other experts from across previously mPaS!Jires 1. and new measures submitted for NQF criteria. All are evaluated against Importance to Measure and Report Reliability and Validlty-Sclentifk Acceptability of Measure Properties Feasibility 4. Usability and Use 5_ Comparison to Related or Competing Measures NQF proactively seeks measures from the field that will help to fill known measure gaps and that align with hea!thcare improvement priorities. NQF encourages measure developers to submit measures that can drive meaningful improvements care, particularly outcome-focused measures. NQF multistakeholder committees evaluate measures for endorsement twice a year, with submission year. By implementing this the spring and review process, NQF has reduced standing committee downtime, allowing measure devel.opers to receive a timely measures, and is to available in Measure More of the evolving system. Evaluation Criteria and Gt~idance for Evaluating Measures for Endorsement. 11 1\!C>F->,..,rl"r·<AI'I measures undergo evaluation maintenance of approximately every years. The maintenance process ensures that NQF---endorsed measures represent current clinical evidence, continue to have a meaningful opportunity to improve, and have been implemented without negative unintended consequences_ a maintenance review, NQF multistakeholder committees review previously endorsed measures to ensure they still meet the criteria for endorsement. This maintenance review may result removing endorsement for measures that no longer meet rigorous criteria, facilitating measure harmonization among competing or similar measures, or retiring measures that no longer provide opportunities improvement. Measure Endorsement and Maintenance Alkl~ol'lnnllo:nm!l•nts received HHS funding to convene l4 multistakeholder topic·spedfic standing committees NQPs redesign of endorsement process created the a measure for NQF endorsement spring and twice of each year, Measure developers may submit measures for during these designated measure review cycles. Funding received 2018 created three opportunities for measure submission and review; the completion of the review of measures submitted November 2017, and measure review cycles initiated in April 2018 and November 2018. The next review cycle is scheduled for initiation in April 2019. To review these measures, NQF convened multistakeholder standing committees However, not all measure endorsement 14 topic areas. received measures for review each cycle. In these instances, standing committees convened to discuss overarching issues related measurement in their VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00068 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.038</GPH> jbell on DSK3GLQ082PROD with NOTICES 18 30150 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices area. Through projects completed """'""""'~~lists the review. summaries of endorsement completed before end of the year. All-cause Admissions and Readmi$sions a patient is admitted to a hospital within a specified time A hospital readmission can be defined as the hospital. v Reducing avoidable admissions and period after having been previously discharged readmissions to acute car·e facilities continues to be an important focus of quality improvement across the healthcare system, as readmissions can result in higher healthcare spending and can lead to patients being exposed to additional safety risks.u A June 2018 report from the Medicare Payment Advisory Commission (MedPAC) states that effo1ts to reduce avoidable readmissions in recent years have a net savings to the Medicare program of approximately $2 for tr;:,,rlitinn,,f Advantage beneficiaries and are being applied The fair and accurate measures of admissions and on reducing unnecessary readmissions are needed. Concerns have been raised about challenges such as sa;cioeo~n<)!\lic status on a person's ol readmission, the rel~tionship influence of a between readmission rates and mortality, and the difficulty of determining an appropriate target rate of readmissions as some readmissions are unavoidable and necessary for quality patient care. NQF's portfolio currently includes 48 endorsed all-cause admissions and readmissions measures including all-cause and condition·spedfk admissions and readmissions measures addressing numerous settings. Many of these measures are used private and federal quality reporting and value-based purchasing programs, ""'''nrmssrnn CMS' Hospital Reduction Program {HRRP} as part of ongoing efforts to reduce avoidable admissions and readmissi'ons. did not receive any measures for the review cycle initiated in November StB,ndin.:~ Committee convened attribution challenges '"""'d"''""inn;" Specilically, the !!dmil>sicms and readmissions"'"'""'""'~ Admissions and Readmissions Standing Committee evaluated one currently endorsed meast1re. This measure was expanded to assess 30-<lay readmissions for various conditions at a new level of analysis: accountable care organizations. Ultimateh,t, this measure was endorsed, and the report is expected in January 2019. NQF has ongoing work to review newly submitted measures of admissions and readmissions. Seven measures were submitted during the November 2018 review cycle. Measures are also expected for 2019 cycle. VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00069 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.039</GPH> jbell on DSK3GLQ082PROD with NOTICES 19 30151 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices Behavioral Health and substance Use and substance use rli~<.,rr!Pr<: Behavioral health is a term used to include mental, behavioral, and/or substance use disorders and addresses treatment rli<.nn1Pr<; for individuals either at risk or Performance measurement necessary ensure access to approximately one in five Americans experiencing mental illness. these behavioral healthcare for NQF's portfolio currently includes 50 endorsed behavioral health and substance use measures addressing topics such as alcohol and drug use, care coordination, depression, medication use, tobacco, and physical health. During the November 2017 review cycle, NQF's Behavioral Health and Substance Use Committee evaluated five new measures. Ultimately, four measures were endorsed, and one measure did not receive endorsement. NQF completed two cycles to review behavioral health measures in 2011!. During April 2018 review cycle, the Committee evaluated two newly submitted measures and seven measures undergoing maintenance review. All measures were endorsed. The final report was published January 2019. NQF ongoing work to review newly submitted measures of behavioral health and substance use. Nc>vemtler 2018 cycle. Measures are also expected for review April 2019 cycle. Cancer Cancer significantly influences mortality and healthcare spending in the United States as neBr!y one· of all Americans will develop cancer during their lifetime, ' 3 Cancer is second leading cause of death for Americans l 4 and treatment costs are estimated to reach $174 billion by 2020. 25 The National Cancer Institute estimates that in 2018, 1,735,350 new cancer cases will be diagnosed and 609,640 Americans will die from cancer. Although 1,600 Americans still die from cancer each day, survival rates are Increasing. In 2016, over 15 million Americans with a his tory of cancer were alive and the number of cancer survivors is estimated to increase to over 20 million by Cancer is a complex disease and its trelltment involves numerous clinicians and providers across of care. The intricacy treatment nece:;sitates that capture cot1rdiru;>tic>n The impact cancer has high-value and rnrmlirnl"!l"'< decision making. NQF's portfolio currently includes 26 general cancer measures as well as measures that address prevalent forms of cancer Including breast cancer, colon cancer, hematology, lung and thoracic cancer, and prostate cancer. These measures address quality across Bn episode of cBre including measures to promote screening and early detection, appropriate treatment (including surgery, chemotherapy, and radiation therapy, and morbidity and mortality}. NQF did not receive any measures for review during the cycles initiated in November 2017 and April 2018. Instead, the Standing Committee convened virtually to provide strategic guidance on how to identify the highest-value measures far cancer care and attribution challenges cancer measurement VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00070 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.040</GPH> jbell on DSK3GLQ082PROD with NOTICES 20 30152 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices has ongoing work to review newly submitted measures of cancer care~ for the November expected April cycle. Cllln:liovasctllar Cardiovascular disease (CVD) cause of death for U~S~ High blood pressure, high and smoking are key risk factors least one of these three risk factors. 29 It kills approximately 610,000 Americans (49 percent) having Americans (nearly one In and costs approximately $200 bl!Hon in health expenditures and lost productivity annually~ 31 Considering the overall toll of cardiovascular disease, measures that assess care performance and patient outcomes are paramount to reducing the negative impacts of CVD. NQF's current portfolio includes 54 endorsed measures addressing cardiovascular care~ These measures address primary prevention and screening or the treatment and care of disease such as coronary artery disease {CAD), heart failure (HF}, ischernic vascular disease {IVD), acute myocardial infarction (AMI}, and endorsed measures assess specific treatments,. diagnostic studies, interventions catheterization intervention {PCi), Implantable and cardiac ,..,,,~,,m!h>tir." the November 2017 review measure four measures undergoing maintenance review. Four measures were endorsed, and one was withdrawn from further endorsement consideration. This project concluded August 2018. In NQF completed two cycles to review cardiovascular measures. During 2018 review cycle, the Committee reviewed one measure undergoing maintenance. Ultimately, this measure was endorsed. The final report was published in January 2019. NQF has ongoing work to review newly submitted cardiovascular measures~ Four measures were submitted for review during the November 2018 cycle~ Measures are also expected for the April 2019 Cost and Efficiency hi~,h.inr,nrT>P the United States spent C0UntrieS1 "'"''"'"~"''"" sm•ndin>' continued to 3.9 percent a trillion or per Despite this high level of spending, the health of the population of the United States is lacking as Americans have lower life expectancies populations of other nations~ greater prevalence of chronic disease compared to the Moreover, as much as 30 percent of all healthcare spending may be on unnecessary or ineffective serv!ce.s~ 3" Measurement is essential to better understand healthcare spending and where resources are being utilized. Measuring healthcare costs is critical to improving the value of care to reduce the rate of cost growth while improving the quality of care. NQF's current portfolio contains nine endorsed cost and resource use measures including both condition-specific and non condition-specific measures of total usil~g per capita or· per hospitalization episode approaches. VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00071 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.041</GPH> jbell on DSK3GLQ082PROD with NOTICES 21 30153 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices did not receive any measures for review during the cycle initiated in November to discuss the new Trial and ""''i"'''""' Instead, the awmnmc111 r;haHengeS Efficiency Standing Committee evaluated in the Hospital Outpatient Quality Re!)Ottin!! ensure that performance measures are producing meaningful results and necessary improvements, highlighting the lack of risk adjustment for factors impacting clinical complexity. This measure did not receive continued endorsement. The final report was published January 2019. NQF has ongoing work to review newly submitted cost and efficiency measures. One measure was submitted for the November 2018 cycle. Measures are also expected for the April 2019 cycle. Geriatdcs and Palliative Care the U.S., the aging population (individuals aged 65 years and older). growing functional !imitations. With the current landscape, inevitable gaps quality of life, comfort, and quality of The need person·centered care therefore vital in mitigating unnecessary medical expenditures and improving the patients and support for family members. life for older NQF's current portfolio includes 2/ endorsed geriatric and palliative care measures including experience with care, care planning, pain management, dyspnea management, care preferences, and quality of care at the end of life, NQF did not receive any new measures for review during the November 2017 and April 2018 review cycles. Instead, the Committee convened virtually to review the current landscape of performance measurement and provide guidance on how to identify high-value measures. NQF has ongoing work to review newly submitted geriatric and palliative care measures~ Five measures were StJbmitted for the November measures address experience with care, care planning, pain management, dyspnea management, care preferences, and quality of care at the end of '""'.'"s"' .,s are also expected cycle. Neurolosv Neurological disorders are diseases the brain, spine, and the nerves that connect them. These neurological conditions can be severe, affecting the normal function of both the cord and the brain by impeding muscle function, lung function, swallowing, and even breathing_ Every year, an estimated 50 million Americans are impacted by the more than600 neurologic diseases and disorders. According to the U.S. Centers for Disease Control and Prevention, 1 in 26 people will develop epilepsy during their life. addition, nearly 800,000 Americans suffer a stroke each year, making stroke the fifth leading cause of death in the natlort 4QThe Alzheimer's Association estimates that more than 5 million Americans are living with AL~:heimer's disease and the disease as cause of death VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00072 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.042</GPH> jbell on DSK3GLQ082PROD with NOTICES 22 30154 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices older Individuals in the United States. The estimated cost of care for people with dementia was $277 portfolio epilepsy, multiple sclerosis, dementia and Alzheimer's disease, Parkinson's disease, and.-.-~'"""'"'~"" These measures are intended to improve care for millions of Americans with neurological diseases and disorders. NQF did not receive any new measures for review during the November 2017 cyde. NQF did not review measures for either of the two cycles offered in 2018. During the AprH 2018 cyde, submitted measures were deferred to a later review cyde. Patient Experience and Function Over decade1 there have to the healthcare paradigm one that identifies persons as passive recipients of care to one that empowers individuals to participate actively care. The presence healthcare delivery. Measures address how healthcare organizations include individual patient preferences, needs, and values while !m,nrr•vir>!:l practices care. Measures also ensure that accountable structures and processes are place for cornmunication and integration of comprehensive plans of care across providers and settings that align with patient and family preferences and goals_ NQF's current portfolio includes 56 endorsed measures addressing concepts such as functional status, communication, shared decision making, care coordination, patient experience, and long-term services and supports_ During the November 2017 review cycle, NQF's Patient Experience and Function Standing Committee evaluated four new measures. None of which were endorsed. This project concluded in August 2018. During the April the Committee evaluated two new measures. Both of these patient-reported nu!rrnmP (PRO} measures were Thl() final report was in January 201.9. were submitted quality of me, patient and family engagement in care,, functional Patient Safety Patient safety failures cause hundreds of thousands of preventable deaths each year; a recent analysis estimated that up to 440,000 Americans die annually from medical errors in United States hospitals. NQF's current portfolio of 7 3 endorsed patient safety measures includes medication safety, falls, venous thromboembolism, mortality, pressure ulcers, healthcare-assodated infections, falls, and workforce and racl!ar;nn safety. VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00073 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.043</GPH> jbell on DSK3GLQ082PROD with NOTICES 23 30155 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices During the November 2017 review cycle, NQF's Patient Safety Standing Committee evaluated one measure focused a national Ultimately, this April 2018 review cycle. Instead, the convened were evaluated virtually to discuss strategies for identifying high-value measures and to provide guidance on how to a more standardized way. NQF received six measure medication reconciliation for review during the November 2018 cycle. These measures address pressure ulcers, healthcare-acquired conditions, sepsis, mortality rates, and medication management Measures are also expected during the April 2019 cycle. Perinatal and women's Health 2017, there were approximately 4 U.S, connection with approximately expectant and new mothers had dangerous and tlfe~threatening conditions, and between 700 and 900 women died as a result of pregnancy and childbirth Despite perinatal healthcare accounting <'nlnt!l~u•·~ to rank last the expenditure in U.S. healthcare l$111 maternal the Industrialized in the There are vast disparities reproductive and perinatal healthcare and outcomes among different racial and ethnic groups making concern for women, mothers, families, and the providers who for and quality measurement, •~ NQF's current nn:rtfl>lin accordingly, making this ar'ea important endorsed meascwes indudes reproductive health, pregnancy, labor and delivery, post-partum care for newborns, and childbirth-related issues for women. No measures were evaluated during the November 2017, April 2018, or November 2018 review cycles. Instead, the Committee discussed strategic issues in perinatal and women's health measurement such as identifying high-value measures, considering the need for "balancing" measures, or measures that can potentially mitigate an unintended or adverse consequence within a spedfk measurement focus, and providing guidance on measure concepts Measures are expected for the April under development. cycle. Prevention and Population Health United ranks lower many other hea!thcare than any other nation, more and healthcare. Medical care has with behaviors such as smoking and low educational achievement and nations on spends and continues to struggle relatively small influence on diet, physical environmental hazards, and social factors (e.g,, Social, environmental, economic, and behavioral factors all play a significant role in maintaining and improving health and well-being, These and other determinants of health contribute to up to 60 percent of deaths in the United States, yet less than 5 percent of health expenditures target prevention. •• NQF's current portfolio includes 34 endorsed measures that include immunization, pediatric dentistry, weight and body mass index; community.level indica,tnt·~ of health al!d disease, and and/or ~er€'e11lrl1Q. VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00074 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.044</GPH> jbell on DSK3GLQ082PROD with NOTICES 24 30156 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices During the November 2017 review cycle, Prevention and Population Health Standing Committee evaluated un,der·!!oin!! ""~''"'"'"""''''review. Ultimately, and two measures did not maintain Prnckll·~.,,m,,nt. April 2018 review cycle, the Committee evaluated one measure undergoing m::•int·"""'"'', review. This measure focused on primary prevention and/or screening. Ultimately, this measure was endorsed. The was published in January final NQF has ongoing work to review newly submitted measures of prevention and population health. Four measures were submitted for the November 2018 cycle. Measures are also expected for the April 2019 cyde. Primary care and chronic Illness Primary care offers a unique opportunity improve the health of people and populations,, as well as being a place where effective care management is practiced. In the primary diagnosis and treatment of the entire patient, rather than a is given lllness persists disease. exl1ihitlni>'any symptoms, thus impact, and Americans are living with diabetes, while 86 estimated total cost of diagnosed diabetes has representing a are identified as from $245 billion in 2012, to percent cost increase over a five-year High-quality performance measurement that captures the complexity of primary care and chronic illnesses is essential to improve diagnosis, treatment, and management of conditions, NQFs portfolio of measures may focus on nonsurgical eye or ear, nose, and throat conditions, diabetes care, osteoporosis, rheumatoid arthritis, gout, back pain, asthma, chronic obstructive pulmonary disease (COPD), and acute bronchitis. l""nrnrflltir,.,.evaluated seven measures undergoing maintenance review. Six measures were endorsed, did not receive endorsement. was published work to review newly January measures of primary care and Two measures were submitted for the November 2018 cycle. Measures are illness care. expected the April Renal Renal disease is a leading cause of death and morbidity in the United States . afflicts over 700,000 people in the United States and M"'A'""'""' for people under the age of 65. NQFs current VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00075 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.045</GPH> jbell on DSK3GLQ082PROD with NOTICES 25 30157 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices portfolio of 21 endorsed renal measures includes dialysis monitoring, hemodialysis, peritone;a! dialysis ;as well safety. m~,;as,,.±re-s were evaluated during Renal Standing Committee cycle, evi~luare•a kidney-pancreas transplant waitlists. Both measures received a reconsideration of endorsement request and are Standing Committee. The final report was published in \tndergoing further review by January 2019. No measures were submitted for the November 2018 cycle. However, measures are expected for the April 2019 cycle. surgery of Americans undergo surgical procedures each year, and the rate of these procedures is increasing annually, with 51.4 m11lion innati<Bnt procedur·es performed In In stays) involved operating room !J"'""'''u' ac•co!mt:ed for nearly half of total hospital costs-" 1 Consumers are increasingly turning to public reports stays (excluding maternal and to make ""'""'ms improving surgical care and given increasing rates surgical un>Cieuur costs1 gaps persist in performance measurement and reporting that impair efforts and quality of surgical care. measurement and reporting provide an opportunity to further improve the safety and quality of surgical care. NQFs current portfolio includes 62 endorsed surgery measures, one of its largest, addressing cardiac, vascular, orthopedic, urologic:, and gynecologic surgeries, and including measures for adult and child surgeries as well as surgeries for congenital anomalies. The portfolio also includes measures of perloperat!ve safety, care coordination, and a range of other clinical or procedural subtopics. However, significant strides have been made in some areas, measure gaps remain procedures. Additionally, effective are needed certain types of evallmte and improve surgical quality, shared l'lccountability, and patient·centered care. the November 2017 review cycle, Standing Committee evaluated two new m•'"'"""'" and one measure undergoing maintenance review. All three"""'""'"''"' project concluded in August 20Ut During April 2018 review cycle, the Committee evaluated two measures undergoing maintenance review. Ultimately, both measures The final report was published in January 2019. NQF has ongoing work to review newly submitted measures of surgery care. Fifteen measures were submitted for the No11ember 2018 cyde. Measures are also expected for the April 2019 cyde. VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00076 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.046</GPH> jbell on DSK3GLQ082PROD with NOTICES 26 30158 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices V. Stakeholder Recommendations on Quality and Efficiency Measures and National Priorities of the requires the CEJ£ to include related to multistokeholder gt'OilfJ input on the selection measures from among.: (i) such measures that have been endorsed by the entity,: collection or reporting of qua/it)!' and efficiency used or proposed to be used by the measures. Additionally, it requires that this report describe matters related to multistakeholder input on national p.riarities for improvement in population health and in delivery of health care services for mann"'"' a.cm1rm'~ consideration under the National Quality Strategy. Measure Applications Partnership Under section 18EIOA of the Act, HHS is required to establish a pre-wlemoking process under which a consensus-based entity (currently NQF) convene multistakellolder groups to provide input to the the selection measures for ose in The list considering for selection is to be publicly published no later than December 1 of each year. No than Febmarv 1 of each vea1; the COI7senstJS·iDas:ea entil)1 is to in pat of the multistakeholder will be considered b~' in the selection of quality and efficiency measures."" NQF convenes the Measure Applications Partnership (MAP) to provide guidanc:e on the use performance measures ln federal healthcare quality programs. MAP makes these recommendations pre-rule making process that enables a multistakeholder dialogue to assess measurement these programs. MAP includes representation from both the public and private sectors and includes patients, clinicians, providers, pun::hasers, and payers. MAP reviews measures that CMS is considering implementing and provides guidance on their acceptability and value to stakeholders. MAP was first convened in 2011 and completed its eighth year of review 2018. measures Lmder """'~~i,r~,.,r,.t1m'l and the process allows for the <"''m'~"'"" deliberations. For detailed information regarding MAP representatives, criteria for selection to MAP, and rosters, please see and ~~~~· aims to provide input that ensures the measures used in federal programs are meaningful to all stakeholders. MAP focuses on recommending measures that empower patients to be adive healthcare consumers and support their decision making, are not overly burdensome on providers, and can support the transition to a system that pays on value of care. MAP strives to recommend measures that will improve quality for all Americans and ensure that the transition to value-based purchasing and alterr1ath1"' payment improves access, while reducing costs all. VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00077 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.047</GPH> jbell on DSK3GLQ082PROD with NOTICES 27 30159 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices Pret·Rtllerna~:ine: Input MAP published the findings of its pre-rule making deliberations in a series of reports MAP recommendations on value-based payment programs ambulatory, and post-acute/long·.term settings 1 ;;:::;;~~~=~:~Additionally, MAP began new work provide consideration for 10 HHS programs. Reports on this work are expected February and March 2019 .. MAP's pre-ru1emaldng recommendations reflect its Measure Selection Criteria and how well MAP believes a measure under consideration fits the needs of the specified program_ The MAP Measure Selection Criteria are designed to demonstrate the characteristics of an ideal set of performance and private MAP also promotes person-centered measurement, a!i!mnner1t and the reduction of healthcare n»n;u-lm•s addr.,.;<:in~:~ clinician or accountable or~•aniin'ltinn under consideration (ACO) measurement, recommendations~ Merit-based Incentive Payment System (MIPS). MIPS was established by section lOl(c) of MACRA. MIPS is a pay-for-perlor·mance program for eligible clinicians, MIPS applies positive, neutral, and negative payment adjustments based on performance in four categories: quality, cost, promoting interoperabilltv,. and improvement activities~ MIPS is one of two tracks the Quality Payment Program {QPP). MAP reviewed measures for the MAP supported three measures and conditionally supported 17 measures, including nine measures that promote affordabflity of care by assessing hea!thcare costs use pending receipt oi NQF endorsement. MAP recommended that two measures under ""'''<irl<w::.tr''" be refined and rulemaking. The rnmnnlt-lr<><> but to implementation in particular, MAP emphasized the importance of completing measure testing at the clinician level ol analysis prior to implementation in the MIPS program. Measures for MIPS on the 2017 MUC list were under consideration for potentia! implementation in the measure set affecting the 2021 payment year and future years. Medicare Shared Savings Program. Section 3022 of the Affordable Care Act (ACAj created the Medicare Shared Savings Program creates an opportunity providers and Shared Savings suppliers to create an Accountable Care Organization (ACO). An ACO is responsible quality of the care for an cost and population of Medicare fee-lor-service beneficiaries. For ACO:. progrilm in 2017 or 2018 there were multiple participation {1) one-sided VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00078 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.048</GPH> jbell on DSK3GLQ082PROD with NOTICES 28 30160 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices model (sharing of savings only for all three years!, (2) two-sided risk model (sharing of savings and losses a.nd (:'!) years) with preliminary all pre-rulemaking MAP reviewed and conditionally supported measures for the Shared Savings Program. MAP conditionally supported two measures addressing diabetes care, noting the importance of these measures given the prevalence of diabetes set is as parsimonious as possible and that there are no competing measures conditionally supported one measure addressing the use of aspirin or anti~platelet medication for ischemic vascular disease, again emphasizing the need to ensure there are not competing measures in the program. These measLJres have not yet been proposed by CMS for addition to the Shared Savings Program measure set. An overarching theme of MAP's pre~ru!emaidng recommendations Savings Program was the need improvements with balance and actionable measurement. MAP recognized the tension between developing measures that address important MAP ml'•mr>~>e< the importance noted that measures that give actionable information are more likely to be acceptable clinicians. MAP emphasized the need to ensure that the information generated by these measures is actionable and allows clinicians to understand how they can improve their performance. MAP members encouraged CMS to provide detaifed data to clinicians, as detailed data are more actionable for clinicians than an aggregated measure score alone_ MAP also emphasized the importance of providing equitable care and that appropriate risk adjustment can help ensure that clinicians who care for more complex and vulnerable patients are not penalized with lower measure scores for factors that these clinicians cannot controL MAP Hospital Workgroup MAP Workgroup ""'·''""''""~'~ programs, hospital and setting~specific End-Stage Renal Disease Quality Incentive Program. The End-Stage Renal Disease Quality Incentive {ESRD QIP) a valLH'!-based program established dialysis facilities treating patients with ESRD. Payments to dialysis facilities are reduced if facilities do not meet or exceed the required total performance score established by CMS for the year. Payment reductions are on a sliding scale, which could amount to a maximum of 2 percent per year. MAP reviewed three measures under consideration for the ERSD QIP program, supporting one and conditionally supporting two. PPS-Exempt Cancer Hospital Quality Reporting Program. The Prospective Payment System (PPS)Cancer Hospital Quality Reporting (PCHQR) Program is a voluntary reporting program for PPS-exempt cancer hospitals. VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00079 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.049</GPH> jbell on DSK3GLQ082PROD with NOTICES 29 30161 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices MAP reviewed and supported one measure under consideration for the PCHQR program. Ambulatory Surgery Center Quality Reporting Program. The Ambulatory Quality R"'''"n'in<> (ASCQR) Program is a n<J\r-far-n~oc,rtir1Q (ACSs) that Hospital Outpatient Quality Reporting Program. The Hospital Outpatient Quality Reporting Program is a pay-for-reporting program. Subsection (d) hospitals that fail to meet program requirements receive a 2 percent reduction in the annual payment update. MAP reviewed one measures under consideration for the Hospital OQR Program. MAP did not support the measure. Hospital Inpatient Quality Reporting Program/Medicare and Medicaid Promoting lnteroperability Program. The Hospital Inpatient Quality Reporting Program is a pay-for.reporting program that requires subsection (d) hospitals to report on process, structure, outcomes, patient perspectives on care, efficiency, and costs of care measures. hospitals that do not participate measures under consideration for meet prog1·am is reduced by one-quarter. MAP reviewed three requirements, the applicable percenta!i!e Hospital Program and/or Promoting lnt<"rrm<"ral1illlcv Programs, conditionally supporting two, and suggesting refinements to The MAP Hospital Workgroup noted provider burden and provide better information cost and quality issues through measurement with the finite resources available. MAP noted that greater alignment across public and private payers is a strategy to minimize the of measurement while maximizing the power of value-based purchasing incentives. .Aligned measures could also help consumers make more informed choices about where to seek high-quality care, especially for treatments that could be provided in different settings. MAP Workgroup The Measure Applications Partnership (MAPI reviewed measures under consideration for one setting· federal program addressing post-acute •-~~-- ..:-- (PAC} and long-term (LTC), making the recommendations Skilled Nursing Facility Quality Reporting Program. The Skilled Nursing Facility Quality Reporting Program !SNFQRP) is a pay-for-reporting that applies to freestanding SNFs,, SNFs affiliated with acute care facilities, and aU noncritical access hospital swing-bed hospitals. SNFs that do not the required data with respect to a fiscal year are subject to a 2 percent reduction in their annual payment rates for the fiscal year. MAP reviewed and supported one measure under consideration for the SNF QRP. Additionally, the MAP PAC/LTC Workgroup noted that important progress has been made in addressing critical measurement gaps but that important concepts remained unmeasured. In particular, MAP emphasized the importance of care coordination in post-acute and long-term care, as patients may frequently transition between sites of care. The PAC/LTC Workgroup also provided guidance on additional potential gaps in the Merit- VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00080 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.050</GPH> jbell on DSK3GLQ082PROD with NOTICES 30 30162 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices that post·acute and long. term care clinicians may find it Based Incentive Payment System (MIPS), that allow participate 2018 Measurement Guidance for Medicaid and CHIP of the largest purchasers the United States, serving neady 7 3 Medicaid and services in almost half of the people are the nation's low- population, 61 Medicaid covers many individuals with a high need medical and healthcare services, including the growing population more than 11 million individuals who are dually eligible for both Medicare and Medicaid_ Medicaid beneficiaries with complex care needs account for roughly 54 percent of total Medicaid expenditures, despite comprising just 5 percent of all Medicaid beneficiaries. &J Moreover, Medicaid covers nearly 50 percent of all births as well as 40 percent of children's healthcare Understanding the needs of adults and children who imperative for improving on Medicaid for their- and the quality of their care. key areas. its recommendations stn!!'ngrtne.•n#n~g 20:1.8$5 the Core Set called forthe of a Set of Health Care Quality Measures for Adults Enrolled Medicaid {the Adult Core Set) to assess the quality of care for adults enrolled in Medicaid. HHS established the Adult Core Set to standardile the measurement of healthcare quality across state Medicaid programs, assist states in coUecting and reporting on the measures, aM facilitate use of the measures for quality In January measures in partnership with a subcommittee to the National Advisory CounciL ~'The 2018 Adult Core Set contained 33 healthcare quality measures. 2012, HHS published the initial Adult Core Set Medicaid Adult recommended improvements Set. The the Workgroup identified high,priority gaps where more or better quality measures are needed~ ~!2!Z.!~Ul· In its final and sixth set of recommendations the Adult Core Set, Workgroup reccwnmended up to eight measures August quality long-term received ln a community setting, use, tobacco and alcohol cessation, and access to medication. The Workgroup supported the removal of two measures from the Adult Core Set The Workgroup noted states' reporting challenges regarding data colllec:tlon for one measure and potential duplication with the reporting hospitals by The Commission_ For the other measure, the Workgroup noted the reporting challenges camed by the measure's data source and by confid<$ntiality laws. This further exemplifies MAP's role measurement burden ,and increasing data collection feasibility. reducing VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00081 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.051</GPH> jbell on DSK3GLQ082PROD with NOTICES 31 30163 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices states voluntarily reported data for the Adult Core Set, up from 41 cu'""'u" •m'""''"'""' Adult 011'\Q i"olt,lCIIt!>. r.t'f'!lt[f'l•pt•< r:ornrTmrunrlevel factors that adversely affect health and healthcare outcomes. Strengthening the Core Set of Healthcare Quality Measures for Children Enrolled in Medicaid and CHIP, 2018"'s Under SSA Sectionl890{b){l)(fJ) the NQF is required to synthesize evidence and convene key stakeholders to make recommendations an priorities for health care performonce measurement in all applicable settings. In making recommendations, the NQF must toke into account measures that may assist consumers and patients in making informed health care decisiol1s1 address healtll disparities, and, address the continuum of care a patient received, including services furnished tw multiple health providii!rs or practitioners and mu!tiplii! The ,..,,,.,".e~·· HHSto children's healthcare. This develop standards to measure identification of the Core Set of Health mandate led to the Measures for Children Enrolled {the Child Core Set). CMS released the Medicaid and Child Core Set in 1010. Measures the Child Core Set are relevant to children ages 0-20 as well as pregnant women because these measures address both prenatal and postpartum quality-of-care issues. CHIPRA also required CMS to recommend updates to the initial Child Core Set annually beginning in January 2013. The 2018 Child Core Set contained 26 ne<mr.ca•·equality measures. Medicaid Child Workgroup recommends improvements to the Child annually. The Workgroup also has identified high-priority gaps where more or better quality measures are needed r>"'rorr•m••nd;;,t1r1n~ on the Child August of six measures cell and patient expet·ience from the set. state reported at least one of the Core Set measures for Adult Core Core Set has allowed states to build their measure- Set, the gradual addition of measures to the reporting infrastructure, as evidenced by the increase in the number states voluntarily reporting on measures. The Workgroup suggested maximizing the usefulness of data collection as well as lowering the burden of data collection_ In particular, the Workgroup highlighted the need for better data on social determinants of health (SDOH), noting agencies identify the needs of specific populations_ Moreover, better information an SDOH could allow Medicaid agencies, providers, and payers to consider nondinical community level factors that lack funding yet adversely affect health VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00082 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.052</GPH> jbell on DSK3GLQ082PROD with NOTICES 32 30164 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices review of the Medicaid Adult and Core Measure Sets was with the r·eport to provide greater Meo;<;ii;o transparency about and CHIP program administration and outcomes. The Scorecard is also a rescn.m:e states and CMS in aligning efforts to drive improvements, at the federal and state-levels, assist the health outcomes of the Medicaid/CHIP beneficiaries and in the administration of these programs. The Scorecard is divided into three pillars: state health system performance, state administrative accountability, and federal administrative accountabilfty. Each of these areas contain state and federally reported measures. convene the Medicaid Adult and Workgroups to pmvide input to HHS on the state health of the Mli!:'dtc:<ud This one-year the selection of VI. Under section 1890(b)(S)(A)(iv) of the Act, the entity is required to describe the annual reportr;Japs in identified b}' HHS under the agem:;y's National Qua!itjl StJ'ategy, and where qualiti' and efficiencv measures are unavailable or inadequate to identify or address such gaps. Gaps Identified in Completed Projects 2018 During their deliberations, NQFs endorsement standing committees discussed and identified gaps that exist current project measure portfolios. A can found of these gaps included in related reports issued in 2018 AQpendix J, the pre-rulemaking process, MAP also nn1rlfr>lin,~ The Measure published by CMS prior to the commencement of workgroup deliberations. ;r~ .."•"r;,. high-priority domains identified by CMS program VII. Gaps in Evidence and Targeted Research Needs Under section 1890(b)(5)(A)(v} of the Act, the entitv is required to describe areas in which evidence is insufficient to support endorsement of quality and efficienq measures in priority areas identified by the VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00083 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.053</GPH> jbell on DSK3GLQ082PROD with NOTICES Secretary under the National Qualitv Strateg}' and wlu!!re targeted reseatch may address such gaps. Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices 30165 to create needed strategic approaches, or frameworks, to imlorc.virli! health and healthcare but for which quality nonexistent. framework Is a A for organizing ideas that measure a topic area and for describing how measurement should take place (i.e., whose performance should be care settings where measurement needed, when measurement which individuals should be included in measurement). Frameworks provide a structure for organizing currently available measures, areas where gaps exist, and prioritization for future measure development NQF's foundational frameworks identify and address measurement gaps in important healthcare areas, underpin future efforts to improve quality through metrics, and ensure safer, patient·centered, cost· effective care that reflects current science and evidence. projects to create strategic frameworks for populatil:m·based trauma outcomes, healthcare system readiness, chief complaint·based quality devefoolln!! a systematic way to feedback emergency care, and In other work, NQF efforts to support structured and other care settings. NQF completed a project to identify measure concepts that can improve the quality and safety care in ambulatory care settings. Population-Based Trauma Outcomes According to the Centers for Disease Control and Prevention, trauma, including both non·intentional and intentional injuries, is the fourth leading cause of death in the United States. Furthermore, it is the leading cause of death in individuals ages 1-46" In addition to the loss of life and potential lasting disabilities from trauma, the financial impact of trauma on both the healthcare system and society is significant. Injuries result in 40 milllon emergency department (ED) visits and 11.2 admissions every year in the US" age$ In hospital highest condition-related expenditure total among of trauma-related disorders ($56. 1 was for Despite the magnitude and expense quality of care. Performance trauma, there are few performance measures that address the an opportunity key of care for me~as,ure's conditions or settings of care identify levers and areas where focused attention can improvement in the quality of care. 2016 report A National Trauma Care System,, the National Academies of Science, Engineering, and Medicine (NASEM) convened a committee to examine military and civilian trauma sy~tems to identify opportunities for improving the quality of trauma can~" The committee noted the absence of standard, national metrics for trauma care, and called for further development of measures in this area. Measurement related to trauma care pre$ents unique challenges, such as assessing and attributing performance across the trauma care including prehospital care (e.g., emergency medical and coordination of patient transport) and post-acute care VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 rehabilitation). Responsibility distributed among multiple stakeholders, including regional and Frm 00084 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.054</GPH> jbell on DSK3GLQ082PROD with NOTICES for patient care and patient outcomes 30166 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices "'''"'"""'ltv actors. Measures that promote shared accountability, such as popu!at1on"level measures, gn!Nilter integration to identify areas for measure development and gaps This one-year project, in cnl!;;~,nr;~N''"' with the HHS Office Assistant Secretary for Preparedness and Response (ASPR}, will inform the development of measures related to the quality of care and synthesize evidence to identify promising approaches to measurement in this area. A report 15 expected in May 2019. Healthcare Systems Readiness Preparing and responding to natural or manmade disasters-such as bioterrorism, disease outbreaks, and inclement weather·-is an essential part of meeting the nation's hea!thcare improving healthcare and public health systems and capacities for health security threats has been a focus in recent years. Despite substantial progress, complex challenges persist, and preparedness efforts may sufficient. Despite the development of cross·sector programs nation's preparedness capabilities during national and regional emergencies, many parts of the remain unprepared for emergencies. Results from the 2017 National Health Security Preparedness Index show preparedness improvements,; however, large differences in are on~m1redness capabilities the U.S. with some regions lagging significantly behind the rest of A successful and robust response to health threats requires collaborative action and engagement healthcare facilities,; however1 there remain challenges between public sector entities and private in applying incentives to improve the quality and effectiveness of these capacity-expanding efforts. The current landscape of healthcare system readiness measurement includes critical and relevant me tries for public health and disease surveillance programs, There is, however, a lack of quality and accountability me tries specific to health system readiness to incentivize private-public partnerships within the healthcare sector to ensure the delivery of high-quality care during times of system stress with the goal of improving person-centered care.• value, and cost efficiency. convened a multistakeholder Expert develop a measurement framework to assess the readiness of hospitals, healthcare s.ystems, and communi tie$ to respond to and recover from disasters and health emergencies. This project will define the concept inform the development of measures related quality of the system readiness system's response to emergencies. A report is expected in COirnplairtt Based Quality for Emergency Care Emergency physician~ are playing an increasingly important role in the delivery of acute, unscheduled care. The National Center for Health Statistics estimates there were 141.4 million ED visits 2017. The majority of ED care focuses on diagnos.ing and treating a patient's chief complaint or the reason for the person's visit rather than addressing a definitive diagnosis. A patient's chief complaint describes the mo~t significant symptoms or signs of illness (e.g., chest pain, headache, fever, abdominal pain, etc.) VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00085 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.055</GPH> jbell on DSK3GLQ082PROD with NOTICES caused him or her to seek healthcare. 30167 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices Current measurement approaches are a practice required cn;m~H<nnr. Mc1reov1~r there is a of standard nomenclature to define how chief complaints are organized, ""l'Pnnnt"n and assigned, a reliance diagnosis-based administrative claims for quality measurement creates establishing valid and patient groups. Currently, there is guidance to ov,etct~nle these barriers to U$e quality rneasurement patients presenting to the ED. NQF has convened a multistakeholder Expert Panel to develop a strategic pian for how chief complaints can be addressed through quality measurement. This one-year project, funded by HHS, will identify performance measures (NQF·endorsed or otherwise), measure concepts, and gaps in the set of available performance measures related to chief complaints, as well as nomenclatures and data sou roes thereof. Additionally, NQF will elicit suggestions the Expert Panel for standardizing complaint-based m"'""'"n""''"· as well as existing assessments of strengths and weaknesses data sources (e.g.,. existing clinical content standards, processed free text, EHRs) for developing either new this space, or new measures that incorporate the patient perspective. A is expected Ambulatory Care Patient According to the National Center for Health Statistics (NCHS), there were apprQ){imately 884.7 million physician office visits compared with 125.7 million hospital visits 2014. 80 A review patient safety in primary care found that incidents happen 2 to .3 percent of visits compared 10 percent of hospitalizations. >I Measurement of patient safety in ambulatory care settings is critical to promoting better and safer care for patients and families. Yet the current landscape of performance measures that can assess patient safety in ambulatory care is poorly understood, as patient safety research and measurement have largely focused on adverse events hospital settings. Several barriers impede the measurement ol patient safety in ambulatory care settings. First., ambulatory care often involves short, or irregular interactions between patients and providers, which makes establishing a Second, the standardized measures itself safety events and interventions exist for Improving patient safety practices providers ambulatory care. Thitd, patients interact with across multiple settings, including processes and outcomes of care. In primary care, which makes to attribute the heterogeneity acr·oss providers, professionals, and patient populations may undermine the comparability of measure results. 2018, NQF concluded a one-year proJect to improve measurement of patient safety in ambulatory care settings and inform the development of priority measures to improve patient safety across ambulatory care settings. NQF convened an advisory panel of experts to identify a representative sample measures and measure concepts that apply to care provided by clinicians, health plans, health systems, and others engaged in ambulatory care. To support this work, "'"''"n'""~"''t"' scan of measur·es and conducted an and found 55 performance and 297 VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00086 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.056</GPH> jbell on DSK3GLQ082PROD with NOTICES 36 30168 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices measure concepts. For the purposes of the environmental scan, NQF defined a measure as an that aggregates data assessment the and care within a and between entitles. NQF potential instrument that Based on a literature review and input from the advisory group, measures and concepts were grouped of following categories: • • medication management and safety; care transitions and handoffs; • diagnostic safety; • prevention of adverse events and complications; and • safety culture. experts who practice or research patient safety in ambulatory care to provide input for measure development based rw'''"'rintinn patterns as some of topical areas for the findings of informants and advisory group members acknowledged the barriers to measure development "'''"u'"""" care. For example, ther·e is a lack of standardized methods for data collectio1n, poor int.Prr•n<>r:>r,mt·v between medical and a lack of funding for support continuous quality improvement. The report revealed significant gaps in research and performance measures that can assess safety in ambulatory care settings. The majority of research has focused on safety in hospital settings, which has created an evidence-base for many patient safety measures that exist today. However, there remains a need to research, measure, and mitigate harm in ambulatory care settings. The lag in patient safety research in ambulatory care has several causes. Primarily, patient safety setting> has yet to receive the national attention that errors ambulator-y care hospital settings have attracted. is lower leading to limited monitoring of patient safety. However, improved rne''"''r"'""•nr patient safety in outpatient settings. an opportunity to better understand and address Common Formats for Patient Under section 1800(b)(5)(A)(v} of the Act, the entity is required to describe areas in which evidence is insufficient to support endorsement of quality and efficiency measures in priority areas identified tw the Secretary under the National Quality Strategy and where targeted research may address s/JI::h g.aps. 2008, AHRQ first released Common Formats to support structured reporting of S<~fety events in hospitals. These reporting techniques standardize the collection of patient-safety event information using common language, definitions, and reporting formats. Use of common data fields for event reporting ensures that information shared with Patient Safety Organizations {PSOs) is consistent across healthcare providers and can aggregated population-level into adverse events. VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00087 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.057</GPH> jbell on DSK3GLQ082PROD with NOTICES 37 30169 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices elements of the Common Formats, inrlur!in<> Beta, The maintained with the goal of improving the Common VIII. Coordination with Measurement Initiatives by Other Payers of the Social Secmii:)i Act mandates that the Annual Report to Congress and the Secreta!}' include a description of the implementation of quality and efficienqi measurement initiatives under this Act and the coordination ofsuch initlativtfs with quality and efficiency initiatives implemented b}' other payers. Exploration of Approach to Measure Feedback Over the decade, the National Quality (NQF) has endorsed more performance measures addressing many important seeks feedback on NQF·endarsed measures curn=••uv developers and stewar·ds endorsement and needed to stronger and more better understand what happens after a measure is implemented. Stakeholders would allow them to better understand how information that measure performs when in use,, and the possible issues or risks that may be associated with the measure's implementation, such as whether a meas~1re is having the intended effect of improving quality of care and health outcomes or evaluating if the measure is causing unintended consequences. By gathering me<lningful, timely, and comprehensive feedback on measures in use, the healthcare quality improvement enterprise can continually improve and the resources required to develop, implement, and endorse measures that drive improvement can be targeted effectively. individuals at all levels of clinical measure performance tracking. For exl:en:si~·e commtmication and easy to use digital provide information for, and contribute data used reason, successful collection of measure feedback will require uu'm'"''"' at levels and as well as Feedback mF•rn;:,ni<n>< can be rolled out across thereby adapting measures for the NQF implementation of a "measure feedback loop", a process that conveys qualitative and quantitative information about measure performance to the NQF standing cmnmlttee members evaluating the measure for endorsement. This 15-month project, funded by HHS, will identify current sources of information about measure performance, explore options for a process to pilot a measure feedback loop, and outline options for implementing the selected plan. A report is expected 2019. VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00088 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.058</GPH> jbell on DSK3GLQ082PROD with NOTICES 38 30170 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices Core Quality Measures Collaborative-Private and Public Alignment A Americans receive care through a value-based care arrangement, one that ties payment to 8oth and private-sector payers use value-biilsed cost efficient Ensuring right quality measures are rtPIIve•rlr"' results that will lead to a stronger, better healthcare system and that goal, the Centers Medicare & Medicaid (CMS) and"'"""''""''< Health Insurance Plans {AHIP)-in partnership with the National Quality Forum (NQF)-have officially formalized the Core Quality Measures Collaborative (CQMC) to improve healthcare quality for every American. The Core Quality Measures Collaborative (CQMC) is a multistake holder, voluntary effort created to promote measure alignment and harmonization across public and private payers. The collaboration aims to add focus to quality improvement efforts, reduce the reporting burden for providers, and offer help them make decisions about where to receive organizations and overseen and Committee, care. The CQMC Steering includes experts from insurance providers, businesses, primaryeare and specialty ~u'-'"'''"~- patient groups, measurement experts, and regional leaders. • • • Recognize high-value, high-impact, evidence-based measures that promote better patient health outcomes, and provide information for improvement, decision making, and payment. Reduce the burden of measurement and voiL1me of measures by eliminating low-value metrics, redundancies, and inconsistencies in measure specifications and quality measure reporting requirements across payers, Refine, align, and harmonize measures across payers to achieve congruence in the measures being used for payment and other accountability purposes. The CQMC has developed and released core sets of quality measures that could be Implemented across commercial and government payers. The principles used by the CQMC developing the reducing sets are that they measure selection, (PCMHI, and Primary • Accountable Care Care • • • • • • • Cardiology Gastroenterology and Hepatitis C Medical Oncology Obstetrics and Gynecology Orthopedics Pediatrics VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00089 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.059</GPH> jbell on DSK3GLQ082PROD with NOTICES 39 30171 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices updating existing core measllre sets and expanding new CQMC members to improvement issues, and topic area. With funding from CMS, NQF developed web site to support the Collaborative, identify priority areas for new core sets, refine the group's measure selection criteria, provide guidance on implementation and offer technical support to the CQMC as well as other stakeholders seeking to use the core measures. More information can be found on the Collaborative's website at IX. Conclusion NQI='s work is fundamental to <tnnn,,rt;n, 01nd priv<~te p<Jyers continue reduce the growth of healthcare ""''m,,nt models require evidem:e-based care provided rather than implemented in a way that minimizes provider burden while advancing national health<: are lmon:>vfom<~nt priorities. The National Quality Strategy outlined a series of national priorities for healthcare improvement including making care safer, strengthening person and family engagement, promoting effective communication, promoting effective prevention and treatment of chronic disease, working with promote best practices healthy and making care 2018, NQF continued to advance these priorities by focusing on work to improve health rural areas. NQf: rn<mn,l<>l""'' work to identify key measures Americans living and explore healthcare faced by rural residents. Ad,ditiom!ilv project provide feedback and re<:ommendations address the low case·votume challenge> faced by many rural providers and convened the Rural Health Workgrollp to provide the pre" rulemaking process. bring high-value, meaningful, and evidence-based performance measures. NQF's work to review and endorse performance measures provides stakeholders with valuable information to improve care delivery and transform the healthcare system. NQF-endorsed measures enable clinicians, and other providers to understand if they are providing high-quality care and where improvement efforts may need to be focused. Similarly, NQF·endorsed measures support efforts by public· and private-sector payers and purchasers to promote value-based purchasing and compare quality across providers. NQF a portfolio of evidence-based measures that address a wide and cross- cutting topic area;. NQF strives to endorse meaningful and high-value measures and recogni<es the VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00090 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.060</GPH> jbell on DSK3GLQ082PROD with NOTICES 40 30172 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices need for measures of healthcare outcomes~ In 2018, NQF endorsed 38 new measures and removed en•:lot·serne:l'\t for 40 measures 28 projects addre!ising 14 NQF remains committed to ensuring 2018, NQF months, allowed for two measure review cycles every year, and enhanced transparency through an expanded 15+ week opportunity for each endorsement NQF also established a Scientific Methods Panel to assist in the review of complex measures and provide methodological guidance across NQF's work:~ NQF also continued to advance the underlying science of measurement through work on attribution and social risk. NQF's Measure Applications Partnership {MAP} convenes organizations across the private and public sectors to recommend measures for use directions federal programs and provide strategic guidance on future these programs. MAP comprises stakeholders from across the healthcare system including patients, its seven years providers, purchasers, and payers,. pre·rulemaking reviews, MAP has aimed to lower costs while improving quality, promote the use of meaningful measures, reduce the burden col!ectioln, and empower patients to necessary to support their hea!thcare rl"'"'~inn·• 35 measures based payment programs covering clinician, hospital, and oo,,h,cu~tellan'''-~"'nn Additiona!ty, MAP began new work in November 2018 to provide inpllt on 39 measures: under consideration for 10 HHS programs. 2018, NQF standing committees identified measure gaps, areas where high-value measures are too few or may not yet exist, but are needed. MAP also identified measure gaps programs, and NQF's Medicaid Workgroup noted gaps federal healthcare the core measure sets: that states use to assess care for adults and children on Medicaid~ work also quality strategic could areas that may not currently be assessed. NQF identified measure concepts to improve quality and safety assess the readiness trauma ambulatory care settings and began can be used work to improve system to respond to and disasters and public health emergencies, and develop a strategic plan for how chief complaints can be addressed quality measurement. Finally, NQF sought to promote coordination across public and private payers to promote the use of high-value measures and support the transition to value while minimizing the burden on clinicians and providers. NQF began work to support the collection of better information about what happens after a measure is implemented to ensure that NQF-endorsed measures are driving meaningful improvements and not causing negative unintended consequences. NQF also began hosting the Cote Quality Measure Collaborative to promote alignment across and private payers through the use of core measw·e sets. VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00091 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.061</GPH> jbell on DSK3GLQ082PROD with NOTICES 41 30173 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices that supports the transition to value by improving the rov·eJ-r1ents tow11rds key health meaningful mea5ures hea!thcare and private payers,, improve health and healthcare value. 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Bethesda, MD: Natlonallnstitutes of Health, National institute of Diabetes and Digestive Diseases,· 2010. Last accessed 2018 VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00096 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.066</GPH> jbell on DSK3GLQ082PROD with NOTICES 46 30178 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices Renal Oata System (USRDS}. USRDS 2018 Annual Data Report: Atlas of Chronic Kidney Disease and Renal Disease in the United States. MD; National Health, National tnl1~;:,.taa·e Agency for Healthcare Research Quality (AHRQ). Most Frequent Operating Procedures Performed in US Hospitals, 2003-2012. HCUP Statistical Brief #186. Rockville, MD: AHRQ; 2014. with a Consensus-Based Entity Regarding Performance Measurement. 42 U.S. 1395aaa{b)(S}(A) [2014). Medicare Access and CHIP Reauthorization Ad of 1015 (MACRA), Pub L No. h!J~:JJJ!!ft!~!;;Q!llir:~~?}{}JQ!!!.QJl!tt!.1;Q!1!ll!i~:b.Q1!a!~illlYJ!!!. las! accessed December 2018. 2018. 'g CMS. Sk.illed nursing facility (SNF) quality reporting program measures and technical information enrollment data enrollment data CMS. October 2:017 Medicaid and CHIP enrollment data website. 2018. CMS. People Enrolled in Medicare and Medicaid Fact Sheet. Baltimore, MD: CMS, Medicare-Medicaid Coordination Office; 2017. h!Jm.:JlJ~~;:m.~Qlll:M:~£:i!r~~!lli;,ill9~2Q!M!S.l:JLQ!J!J:I;~ka.!lt::SID!;l accessed October 2018. CMS. Improving care for Medicaid beneficiaries with complex care needs and high costs website. VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00097 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.067</GPH> jbell on DSK3GLQ082PROD with NOTICES 47 30179 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices NQE Strengthening the Core Set of Heaithcare Quality Measures for Adults Enrolled in Medicaid, 2!J17. NQF; 2017. Musumeci M, Poindexter D. Medicaid Restructuring under the American Health Care Act and Children with Special Health Care Needs. Issue Brief. Washington, OC; Kaiser Family Foundation (KFF); 2017. ~~~~~~~~~~~~~~~~~~WQ~~~~~~~~~~~.~st accessed June 2017. ET, Hu!kower RL, Kaminski JW. Behavioral Health Integration in Pediatric Prirrwr)l Care: Considemtions and Opportunities for Policymakers,, Planners and Providers. New York, Milbank Memorial Fund; 2017.rm~u:tJ!ll!.!~.!!!.!:!.i!1lf~Wl!.l;:!;; in Medicaid, 2017. •• CMS. Qua/it).• of Care tor Children and Adults in Medicaid and CHIP; Overview of findings from the 2017 Child and Adult Core Sets. Baltimore, MD: CMS; 2012. ~~/J:t.~t!.:!J~~!ls!:.!l2l!Lr!.~~!!!L;IJ.lll!ll!:t:£L: 2018, Department of Health and Human Services. Centers for Medicare and Medicaid Services (CMS). tvte1ltcata and CHIP (MAC) Scorecard. ~~f.l:t..!:!'r!!L!!~l£!!Q.J!QY.i.~.J:it:~!l:Yi;~~;m:<~!!ll.l.!li!~!Jl!Jnl· last accessed December 2018. accessed February 2017. United States n Centers for Disease Control and Prevention. Injury prevention and controL m!~W!!!Y!i:!&,!~:.&!lUJ!!ll!I.O!C!t.lli£1;lli/.9J!!ll:~Y!l.~!....!i~!.Jltml.· Last accessed February 2019. Centers for Disease Control and Prevention. Emergency department visits. m!~lll~M~m2JU!l£1]J:L!§!<Hll!!U!t!X~~~~l2S!:!m!!!ll;,.ru;m. Last accessed 2019. VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00098 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.068</GPH> jbell on DSK3GLQ082PROD with NOTICES 48 30180 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices Academies Sciences, >-m'i'"'""""' lntea;rat.ina Mi!it(lry and Civilian Washington, DC: The National Academies 17 National and Medicine . A National Trauma Care S)istem: to Achieve: Zero Prevent(lb/e Deaths After Injury. :2016. Academies of Sciences, Engineering, and Medicine. Examining Challenges and Possible Strategies to Strengthen US Health Security. Washington, DC: National Academies Press; 2018. of Kentucky, Center Public Health Services cand Systems Research, The Natiotwl Health Security Preparedness Index. Lexington, University of Kentucky; incidents in prlrmuy cace. BMJ Qual Sof. :2015;25(7):477· U. Tip of the iceberg: 479. Ackerman Sl, Gourley G, Le G" et at Improving Patient Safety in Public Hospitals: Developing Standard Measures to Track Medical Errors and Process Breakdowns. 1 Patient Saf. Macch 2018. VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00099 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.069</GPH> jbell on DSK3GLQ082PROD with NOTICES 49 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices 30181 AppendiX A: NQF Funding end Operations VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00100 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.070</GPH> jbell on DSK3GLQ082PROD with NOTICES 1. Fed<erallv 30182 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices Appendix B: Multistakeholder Group Rosters: Committee, Workgroups, Task Forces, and Advisory Panels <.:o''~"""';"-'"''"'"'"' entity, NQF its convened committees, workgroups, task forces, and convet1ed 677 volunteers across 30 multlstakeholder groups. Of tl;ese groups, it Included the following: Percentage by Healthcare Sector Healthc:are Sector Provider 43% 1% 4% 19% Patient/Caregiver Consumer Health Professional Supplier/Industry Health Plan QMRI Health Agency Health Plan Public/ Community Health Public Health and Measurement Researcher (PHMR) Chief Complaint-Based Quality for Emergency care Committee CO-CHAIRS Margaret5arnuels~Kalow, MOt MPhil~ MSHP PartnerS Healt!lcare Ariun venbte~, MO, Mllll, MHS Yale University 2% 6% 6% 1% 6% 4% 7% Joltn Keats, MD, CI'E, CI'PS, FACOO, FAAPL Oallidl\1-mM·Toker, MD, flhD Johns Hopkins l!nivarsity School o! Cigna Naghma Khan, MD Medicine University S<:hool of Medicine l(.,.;n K!ooer, 00, £10, FIICEP TeamHealth Joseph Kunisd!, PhD, !!N-BC lnfom-tatii:s, CI'HQ Health Navigator llC Davidlhom~on, MO, fACE!> Anita \l"shi, MD, MPH, MHS Palo Alto Healthcare System Andrew Zinke!, MD, MBA Health Partners MEMBERS Memorial Hermann Health System Jarnie Lehner, MilA, CAPM l\lishant "!iluwn" Anam:l, MD, FIICEP Health Syslem Jennifer llru:Mi MtK<mrl<'lf, MD, FAAF!' lcahn S<:hool of Medicine at Mount Disparities Standing Committee Mi<helle tin, MD, MPH, MS CO-CHAIRS M.,.sh¥111 Chin, MD, MPH, FACP IBiH:anl S!epfloo Cantrlll, MD University of Colorado School of James McClay, MD, MS, FACE!' Uniwnity of Nebraska M"dical Canter llbhishel< Melltotra, MD, MBA, FACEP Unlllerstty of North Caroline Ninez Ponce, MI'P, PhO UCLA Cemer for Health l'olioy ~esearch MEMBERS Gtellll: Miller, MO, FACEP Philip Albettl, PhD Mane!~ Health !'atrid< Dolan, MD Comer Children's Hospital Vltultv Sofie Morgan, MD, MilA Association of American Medical Colleges \il.'ashin~on Un~versity Su"""noo &emheim, MD, MHS l!l<hard Griff""!, MD, MPH, FACE!> Sctences Yale New Ha\l!!rt Health Syst@m Cent&r Washington University Sehool of Oallid Morrill fur0!11<omes Rl!!!!earch a11el Evaluatton V..stibu!ar Oisonlers (CORE) Ml<helle C..brer" SE!IJ Caiifornl~ Washington Juan Emilio Carrillo, MD, MPH Emily Carrier, MD, MS<: Helen Haskell, lVIII Error of Arkansas for Ml!clkai Associatioo/Amlilric•n 1-!e<~rt arm Stroke Assod&Uon S!wen Hom& MD, MMS<:, FACE!' VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00101 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.071</GPH> jbell on DSK3GLQ082PROD with NOTICES 51 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices Usa C®~>er, MO, MPH, FACI' Johns Hopkill$ School of Medicine • nd Cullen C..se, EMI'A, CEM, CiCP, CHEP, SCPM !lloortibetg S<:hool of Pub lie Health Rooald Copel1111d, MD, FlieS {RITN) Kall:<lr Permanente l!arb"rll Citllrella, RN, MS, NHOP·IIC Conmmce Anderst~n, BSN, MilA Jose ltscar<:~a, Mil, PhD Fielding School of Public Health Trad Thomp'""" Fergu,.,.,, MD, Mil<A, !:I'!' Katalyn Oervay, Pham!O, MPH, SCI'S, FASHI' Rose &aez, Rill, MSN, MRA, CPNQ, CPPS Tao1p11 General Hosp~al i!!ue Cross Slue Shfeld Auotiatioo Welltare H""llh Plans, Inc, Alexander Gen., MD, MPH Robert Ceotor, MD, MIICI' Kevin R•tella, MO, MPH University of Alabama at Sirmingham Noncv Garrett, PhD SSM Health Jennifer Greene, MA, lPC Partners Behavior at H""llh HenMpin County Medical Center Management PCP! Rmndation Roman a Ha•Min-Wynia, 1'!10 D<!nver Health Ua I<~:Z:roni, MD, MIS<: M<i$sochusett> Gen'i!tal Hospital O<!vid Nerenz, PhD Henrv Ford Hearth System Yolanda Ogb<llu, PhD, CRNI',Neonatlll Anij:el" HeWlett, MD, MS Dan Culim., MO, l'hD Uni>'<!rsity of Nebraska Medical Canter T"'a" Health and Hum;.n Servic"' University of Rochester Medical Center fl.altimore:, Robert Raune:r, MO, MPH, fAAFP Healthy Lincoln Ed<>ordo!llllldte>, MD, MPH, FAAFP Heart Association Sarah HudllM Scholle, MPH, DrPH National Committee for Quality Assurance Measure Feedback loop Committee MEMBERS Kicln"'' Cemtern $cl>oo! of M•><liclrn> Elvia Chavarria1 I'VIPH Hwl!'lle Jacobs, Dr I'll, MPH, MS Foundation Melody Donko Holsomback Geislng"r Health System Mark la..,...tt, MD, MilA, MS Anne O<!otsdl, liN, PhD lllt<!rMtlO!lol of He<~lth Sciences Matthew Knott, MS, £1'0, CFO, CEM, CEMSO,FM Fire Department !:ll:aoeV Kokaram, MPH Boston Public Health Commission Staten Krill!, MD Trldiii f.lllott, MilA, CPHQ Arm & ~abert H, Lurie Children's Memorial Hermann Health S\"tem lee fl.,sher, MD Mark E. Huang, MD Shirley Ryan Abllitylab ;..,.,,p;, Kunism, PhD Thomas S!!quist, MD, MPH Hrepital of Chicago Edisoo Madhado, MD, MBA Partner> Healthcare 'S\"l<lm Nirolette touissaint, PhD IPRO Christie TEigl""d, !'hO Healthcare Ready Claire Noel-Miller, MI'A, PhD Awlere Health l An loova\orr Company Dwld Maromi, MD, MHS.Ct, FACEP Unilll!fsit',' o! Marvl•"d School of AARI' l'ubllt Poli<::y Institute El<ta Punwa~~l, MHA H""lth JiU Sl!uemaker, RN, CI'H!MS Mara V<>udel"""'·• 10, llM National H""ltll taw Program Medicin" and University of Moryl.ond Healthcare Systems Readiness Committee Glen Mays, PhD, MPH Univ.,rwity of Kentucky College ol Public Pwllll<ldinger, Mil Jamesl'al:llrllll>, MI'A Hospita!/HafiAllrd University The Americanlloard of Family l.)ehorah Struth, MSN, liN, PhD!<! Health Massathusetts General MqaretWeston, MSN, RN,CPHQ OncOlogy Nursing Soc,iety P<ltrid< Reilly, MD, FCCP, FACS Unlver•ttv of PA Health System Korvn Rubio, MHA Medical Associati<:>n Marcie Roth Johns<Jn andJohM<Jn Hea~h tare Sl"tems in<, Partnership fur lndu$lve Disaster Elbabetl! (lll!tl!l Rubinfstein Henry ford Hf!aith System MEMBERS Strategies luqr S>Mtt, PhD, MBA Sue Sherlden, MIM, MU, DHl KaiSer Permanente Northwest Region Society to Improve D1agnosis in Scott Arons®, MS Healtt.care, RPA, a Jensen H~gh"" Company Sue Anne Bell, Phil, fNI'LSC, NHOP·ilC University of Mithigan Si:hool of 30183 Jay T<~Vlor.• MSgt; Pennwlvania O<!p;ortrtl'i!ilt ol Hedh Meditl!le Sara Too"""!, MO, MPhil, MPH, MS.: Basion Chlldmn's Hosp;tol Emili' Carrier, MO, MS.: VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00102 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.072</GPH> jbell on DSK3GLQ082PROD with NOTICES Manatt H~lth 30184 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices Antllwy Grigoois, 1'110 Trauma Outcomes Committee Select Bruce H<!ll, MD, PhD, MBA CO·CHAlRS Peter Tlwrn.,s, JP Law Firm Garth Utter, MD, MSc Av'l!ry 1\!;ri:hens, MD, MPH, PhD, FACS A""'rican Cottage of Surpcn.' C~ie•go Paul H<lldenreich, MD, MS, FACC, FAHA MEMBERS l\linatl<!ggs Robert B&o, MD, fAC£P M~ryland tmrritute fa< EMS Sl"lem• Derek ll""'!'!en, p,.._edi<;. em, Centers for Medicare and Medicaid Ser\liees Br""d"" Carr, MD, MA, MS HHS Office of the Assistant Secretory Stanford Universily School ol Medicine; for Preparedness and Response Medicine; Washington University CEMSO,GO Rockford fire Department Rockford l!rym collier, 00 Carillon Clinic Roanoke Jm"!'h Cuschi<!ri, MO University of Washinston Seattle J-<1s Eob<lnks, MO, FACS Hospital Al"•"ndt!r Garza, MD, MPH SSM Mkbael G<mzalez, MD, FACEP, FAAEM Houston Fire Departm<~n! Houston Sherrie Kaplan, l'hD uc irvine School of Medicine AII..Cause Admissions and Readmissions Committee Busines. Group on Health MayoCHnit Ka!horine Auger, MD, MSc CincinMil Children'• Ho;p~al Medical Elliott Haut, MD, PhD, fAtS C"nter JOhns Hopkins Univers!ly school ol frank llrigp, PharmD, Mi>H Medidne West Vlrg,inia University Healthc,are Grl'l!!'>IV Hawryluk, MD, PhD, R!CSC Jo Ann Brook•.• PhD, RN Univenlty of Utah Indiana llniv<•rsity Health System David lilllngst<m, MO Rutgers New Jersey Medital School Barry Mlil'l<man, MD, MBA, FACS ACI\IIHIC ll~ylor H<lalth Cam Sy>tem Keith Und,JO, MS, BSN Policy Institute Paulette 1\liewayk, PhD, MPH Umform Data System for Medkal Carol RaphMI,MPA Health Solutions John !lt~lpt, 00, MBA G"lsinger Cti51ie Tr<Wi>, MSHHA MEMBERS Kurt HQPpe, MD Washington University School of Brown S<:lwol o! Social Work Consensus Development Process Standing Committees Adil H<llder, MD, MPH, FACS \fA Palo Alto Health Core Sys:tem Karen Joynt Maddo!<, MD, MPH Mllthew Reiclbead, Mil Hosplta! Assoeiatio!\; Hoop~al lndust!V Data inrtitute Pamela !lobem, PhD, MSHA, OI!T /l, SCFES, !'AOTA, CPHQ, 1'1\iAP., FACI!M Cedars~Sinai Medicaf Cehter Derek Robins<m, MD, MBA, FACEP, CHCQM Health Care Service Corporation Thoma• Smith, MD, I'AP.A Columb1a Univer.lty Medica! C•nt"r Mae Centeno, Dl'il', RN, CCRN, CCNS,. COP Behavioral Health and Substance Use Committee HelM Chen, MD CO-CHAIRS Peter Briss, MD, MPH linda Melillo, MA, MS, CPH!lM, CI'XP SUSll!l Craft, Rill Centers for Disease Control and Prevention (CDC), Nali<mal Center for Anna!VIil!er, MD, fACS We;shin!1l:oo University Orthopedics Sage Myers, MD, MSCE Children's Hospital ofl>ennsytvania Craig 1\lcwgan:l, MD, MPH H<!nry f<lfd Health System William Wesley Fields, MD, I'ACEP CEPAmerica StevM fishbM.,, MD North Shore-UJ Health System lor Oregon Health & Science University Network Dialysis Services Jad< S.va, MO MedStar Washlngtoo Hoop~al Center Andrew Schrag, MilA, MA, lPCS Paula Minton Foltz, RN, MS.N Brian fo'jf, MHA MEMBERS Partners Behavioral HM!th Q..Centrix, W:': Mad¥ Chalk, PhD, MSW M•MI!<lment Laurent Glance, MD Treatment Research Institute Dmt!d S.idenwwm, MD, FACR Sutter Health Group University ol Rochester School of Dmtid Einzig:, MD Children's Hospital And Clinics Of Patient Care Services !!1\1'10 Chronic OJ"'"'" Preventioo and Hea~ll Harold Pinrus, MD New Yorl<·Presbyterlan Hospital, The Uni•.,rsity Hospital o! Columbia and CO<n.,ll VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00103 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.073</GPH> jbell on DSK3GLQ082PROD with NOTICES 53 30185 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices Julie Goldstein G!'Umet, PliO Oev.,!opment Cenl>!r/Suidde Shelley 1'\lld NasSQ, MPI' COP Cardiovascular Committee National Coalition for Concer Prevention Resource Center/National CO-CHAIRS MEMBERS MarvGeofll", MD, MSPH, FACS, FAHA Policy and Manal!"men~c Rogel Cancer Cent<ll'slor Disa"" Control and !lrat>deisllniversity Uu J"nsen, DNI', APRil! Veteran'< Health Administration Dol<>ti!Sc (Oodlj Kelll!hllr, MS, DMH 0 Kelleher Consulting Kralg Knudsen, PhD Ohio Department of Mental Health and Tllon>a> Kottke, MD, MSPH Gn!l!<IIY lloai, 00, FCAP Univ@fs!ty ol Colorado H<><prtal Clinical Health Partners laboratOI'f MEMBERS Brent Br"""man, Ph.D, OTR/l, fAOTA S<lnaAI·KIIatib, MD, MHS University of Texa< M,D, Anderson Duke University Medical Center Cam:er Center Carol Allred, I>A Addiction Services Steven Chen, MD, MilA, FACS WomenHeart: The Natkmal Coal~ion Michael R. l!ll'dleri, LCSW OasisMD fur Women with Hearl Disease Northwell Health, Sl!hovloral Heafth Ma<thew fad<tor, MO, FACS linda llaas, PhD, !IN Services Line Toml L. M;orK, 1'110, MBA Geisl"l!"' Medical Center University of CintillMll Held fl'!Yd Linda llrig>, Dill!> ln!ematiooal Rat;lll!l Mazon JeffeM;, MI'H, MIA Rlm<~rd G<!lb, MA The Nicholson Fotmdation Volunteer llemadette Melnyl<, PhD, RN, CPNI'/PMHNI', I"MNI', !"NAP, FMN l!red!Ol'd Hil':!!dh, Mtl Research,: Te••• OncoiOJY Jette 1-!ogenmiller, PhD, M!'l, APRN/ARNP, COl', NTI', TNCC, CEE laurence Miller, MD Oncology Nurse Prac:tltioner University of Arkansas for Medical Brook" P<!dsh, MD l. leonard l.khtenfeld, MD, MACP An:lterican Cancer 5ociety Sti!Phl!lll lmrell, MS Blue Cros> lllue Shield of New MeJ<ito Seattle Cancer Care Alliance Pal ient Sciences Denver Mi<:hael Crouch, MD, MSPH, FMFP Tex!llt A & M University S<;hool ol Eliaabeth Deloo& 1'110 Duke University Medkal CeMer Kumar OharmarajM, MO, MilA Clover Health llllil!iMn Downey, MIJ Carofinas HealthCare Slf'ltem Brian Fomst, MD Davidl'aliJ1!1, MD and Advisory Council Kaiser Perrnanente Jennifer Malin, MD, PhlJ \I"*lim l'lndolia, Pl!armD, MeA Henrv f<lfd Health System jHFHS)/Heaith Al!iaru:e Plan {HAl'] Llu Shea, MD, DFAPA Jodi MarM<:hie, MO, FACi Access Healthcare IJI<el:t University of Pittsburgh, Do!l'lrtm""t a! illaftall Z\lll'rank<!l, MS Jeffery Susmll!n, MD Medical University Mld><~el TrMI!fe, o.!clore Consulting Elh•n Hillega<S, I'T1 !'dO, CCS, FMC\IPR, FAI'TA Physical Therapy Associatk:m Thomas, James, MD !!iaptist Health !>!an and l:l:ilpUst Health llenjemin M<Wsa•, M.D. Sy$tem Oi!llle Otte, Rill, MS, OCN MD Health Partner; Medical Group, Regions Charles Mahllll, l'harmO, Ph(, RPI! 89eriy Rei!lle, PhD, Rill Presbyterian Healthcare Services and lloonie Zftn"- MD, MPH UnM>rsity of Cineirmati College of University of California, Los An:geles {UClA) s.,,.,.,llnstllut" for Nursing R!lbert Rosenberg. MO, fACR UnllierSit\1 of New Mexico .Joel Marrs, Pharm.O, FCCP, FASHP, FNLA, BCI'S·AQ Catdio!oBY, OCACP, Radiology Associates of Albuquerque Dwid J. Siler, MD, MPH University of Colorado Anschutz UTSoothweslem Medical Center Medical Campus Oanie!le Zlemid<i, PllarmO J&J Health<: are $yst<!ms Krisli Mitchell, I\I!I'H Ne-uorscJe:nce ilrttd Hmnan Behavior leslie S. Zun, MD, MBA Sinai Health System COP Cancer Committee CO-CHAIRS ClS \.tC Garv l'ud<rein, PhD Minority Quality Fotum Karen field•, MD Moffitt ~ocer Center VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00104 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.074</GPH> jbell on DSK3GLQ082PROD with NOTICES 54 30186 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices Nidlolz Ruger<>, Mtl, I'ACP, FACC, FSCAI, ~SliM, I'Cl'P K'l!lly Mi<l>llel$00, MD, MPH, F<:cM, FAP CM<>Iynl'ar" Minn.,sota Health Action Group Jnhn lla!liff, MD, fACS, I'AANS Centerfcr !lioothk< and Medical University Mlad"" Vidollidl, Mtl at Chicago, Je><e !!mwn VA Med><al Center Daniel Waxman, Mtl, PhD, FACC RAND, University of California, Los Angeles {UClA) CDP Cost and Efficiency Committee CO-CHAIRS Srinill'as Sridllara, PhD, MHS T!la Advlsoi)' Boord Company Una Walker, P!lD AARP -Public Polity Institute Bill Weintraub, MD, fACC Me<:!Star Washington Hospital Center Herbert Won11,. PhD Agency for H"althcare Research and Quality Dolores 'l'aniill!ih<>ta, MPH llrent A!;p!in, MD, MPH Healthc•re A$$ociation ln<l<!peml.,ot Cheryl Den>berg, 1'110 RAND !lislinguishlld Chair In H<l<lltllcare !'ayment Policy COP Geriatric and Palliative Douglas Nee, Pharm 0, MS Clinical Pharmacist, Self laura Parter, MO Colen Corn:er Allionce Cin<li PurSley, Rill, Cl-lPN VNA Colorado Hospice •nd Palliative Care lynn Reinke, P!lD, ARNP, FAAN VA l'Ufet Sound Health Can• Svstam A111y Sanders, MD, MS, FAAI\l SUNY Upstate Medical Uni-sily Tracy Schrm!pfl!l', P!lO, MSW M~>dison.• Care Committee MEMBERS l<risti"" 1\/!artin AlldetSilfl, MM Boo: Allen Hamilton lanry li<>do•r R, Sean Morrison, MD Patty and Jayllalil!r National Palliative Care Center; National Palii&tiw Care lm}l Fiesinger, MD, FAAFP Research Ce!:nbl!r,~ H@rtzbe!rg PaJli.a:tiv<8 Care Institute, 1calln School of Medicine at Mount Sinat Deborah Waldrop, PhD, tMSW, ACSW Population !i<!alth,, ViHage Family Universltv of Buffalo, S~hool of Social Practice Work Buffalo Nancy Garrett, Ph!) Henl'lepin Coontv Medical Center Andrea Glllze.r, MO, MS, FACP AmerlH<!alth Carilas 1\llchllel Howe, MS, IISN, !IN MEMBERS Relirnd Morv Alln Clari<, MHA Avalere Jennifer Eames Huff, MPH, CPEH Health SUnny !lli!Mnani, MD Dignity Health & honer Health l.l..a Latts, MD, MSPH, MBA, FACP H""'!t!l,I8M Jason t<>tt, MD, MH!I, MSHP, FAAP Bayer US LlC Mamn Mardniak,MPI', PhD Gli!XoSmithKiine lames: Naess@fls:, ScO, MPH Ja<k l\leedleman, 1'110 Fteldin!! S<:hoof of Public HM!th Janis Orlowski, MD, MAC!> Ass<:><:latlon of American Medical Ccli"!!"S Margie A!l<insoo, D 1\i!io, SCC M,..se/B•v C•re Health System Palm Harbor Samira ile<:kwith, u:SW, FACHt, lHO Cllristine S<!el Ritmie, MD, MSPH University of Calilomia San Francisco; Jewish Home of San Francisco Cemer for R@SE!arth on Aging 1\obertSidlow, MD, MI!A,FACP Memorial Stoan Kettering Cancer Center Karl Steinberg, MD, CMO, HMOC life Care C<int<>r of Vista, C•rl•b•d by the Sea Care c.,nter, Hospke by the Sea P~>Ut f. Tatum, MO, MSPH, CMO, FAAHPM1 AGSF University of Missouri·Cofumbla School of Medicine G""&~~llmde!<ieft, MO, MA $er>1ces AmyJ,Jierm<~n,IISN Foufl<lat!oo Eduardo Bruer.,, MD MOAnct:erson Cam:er Center COP Neurology Committee deanne Cass, 00, fAAHPM CO-CHAIRS tl<Nld Knowlton, MA Hospice of Oaytoo <Seorge H<mdzo, tiCC, CSSII S Hes!thCare Chaplaincy Arif H, KliMa!, MD, MBA, MHS, fACP, tl<Nid TirS<em>well, MD, MSc Univers!tyofWashington, Harborlliew FAAHPM Medical Center Duke cancer ln•litute K!itherine li<l>ttnberll,. 00, MPH, O<Nld Andrews Retired MEMBERS FAAFP Medical Center Aothem Blue Cross and Blue Shiold VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00105 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.075</GPH> jbell on DSK3GLQ082PROD with NOTICES 55 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices 30187 l, Metthew Austin, PhD JO<:~ lwtlsta, MD Ci•w.,lond Clinic Nll!urologlc•llnsti!ute of Medicine lent~if"" lh'!illt, MD, MI'H Metrohe<!lth Medical center Amy Bell, 01111', llNC..Ol!, fiii:A·OC, CI'HQ Ketoo l!ulsara, MD Y~~rle Department of Neurosurgery lames !lt~rk<!, MO Mi<he!le C.micia, MSN, RN, PHN, CRRIII, CCM, l'AHA ~"""" roundolion Rellabilitatron Center \l.,{erle Cotter, OrNP, 1\GI'CNP-IlC, FAANP John Hopkins School of Nurning!lCradlbr<IDid<!!r$0n, MD, MMS<: Massachusetts General Hospital Reu~~<m Fer~g1!r, MO Cl!ri•topher Deaii Merlha Cllrter, OtiS<:, MBA, APRN, Bristoi·Myer< Squibb Company CNM llarbara Gage, PhD, MPA WomenCare, Inc George Washington sthool nf M edieil'!e Tra<ry Fl""ag!ll'l, MD and Health Sciences Kairer Permanente Dewn Hohl, RN, BSIII, MS, l'hO Johns Hopkins Home Care Group Health Resources and Servic~:s stephl!!l Hey .Administration Patient fii!mily Ashley Hiroi, PhO Centered Care Partners M-beramblilh Jaleel, MD Sherrie Kaplan, Phi), MPH lrvln<l! School ol Uni\iersit\1 ofT•as, Soutlwveslern lll'ende teath, MHSA, PMP Westat .American College of Nurse~Mic:lwives Dionalolle•, CNM, MS, PhD Melo<!v Rym, l'harmO, MPH University ol Kentucly Cttllege of Pharmaw Jan<> Sullivan, PT, OHS, MS Sarah McNeil, MD Center Jennifer M<>ore, Pit D, RN Institute for Medil:aid Innovation Krist! Nelson, Mill\, !ISN l'atients intermountain Healthcare Julio!t M Nellln•, MD, MPA Kelly Sul!iv®, PhD TBr"""" O'Mal!"lf, MD Partl'lers Healthcare Sy>tem Lenard Pll!'isi, RN, MA, CPHQ, FNAHQ Georgi£! Souti"tem University Metropolitan Jewish Health System Heelth Equity, Johns Hopkins Ro•s Zllfoote, 00 Debra Saliba, MD, MPii UCWJH Son.m Center, VA GRECC, RAND Health Ellen Sohult:t, MS Hooltllcare, LL<:: Cynthia PEllegrini Senior \Ike !'resident, !'ublic Poliey & M~r<:h of Dimes llhmll E, llam"s, MD, MPH, fACOG Hafllard Medical School COP Patient Experience and Function Committee Institute for Research (AIR) u,.. Gele Suter, MD CO-CHAIRS lee Partridge Retired S..nior H""~h Policy .AcMsor Christopher Stille., MD., MPH, FAAP Unlv!!ts!ty of Colorado School d Medicine, University ol Colorado School of Medidn~ & Child,.,n's Hospital Richard Antoo<lAII, MD lntegr<~ted C~re, Soston Children's Sheila Owoos..Co!lins, MD, MPH, MBA Director, Yale/CORE PetB Thomas, .ltl Sutter & lteprodu,tive Health, Department Na<>mi Schapiro, RN, 1'110, CPNP Family Health Care P.C. COP Perinatal and Women's Health Committee CO-CHAIRS l<imbll!'iy Gl'egQIY, MD, MPH Cedars Sinai Medi·cal C@f'lt@r MEMBERS Aetna los 1\ngelm County Public Health Yi!ie School of Mediciru!l, and Gerr! l-11, !'ltD, RN, FAAN Ari~ooa Stat~ University CaM! Sakata, PhD., MSPH NatiOnal Partnership lor Women & Nursing, University of cafifomia, San Francisco Merisa "Mimi" Spalding, JD, MPH Planned Parenthood \fi~e Prestdent, Maternal Child Services, Anthemr 1nt, Sindhu Sriniv.,s, MD, MSCE Families Assoti,.te Professor and Vioe..Chair,. llet!JA~I<,MD MEMBERS HeelthPartners, inc. Jill Arnold Quelity,. Obstetrics and Gy!l&olo!JII, Perm>~,lva1nia Health Adrienne lloi•"'l MD, MA, Matemal Safety FO\lndati.on Harvard Medical sthool jbell on DSK3GLQ082PROD with NOTICES He•lth Care UsaMorme,MA Patient & Family Engagement Affinity Group National Partnership for Northweste:rn Untversttv VerDate Sep<11>2014 Deborah Klldav, MSN !Irian lindberg, I!SW, MMHS 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00106 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.076</GPH> Char!ol:t<!i J<mes, MO, PhD, MSI'H Food and Drug Administration Mid!~ l<aplitt, MD, PhD 30188 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices Rajan W.mh11wan, MD, MMM, CI>E, FAAI> Medital Director of NeonatOI"ll'/, Florida Piltrida Quil!l<l'f, l'ho, MPH, IIRNI', CRRN, FMN, FMNI' Mar.:el Sallve, MO, MPH Institute on Agin$ Jawn Sl>"n!!ler, MO, MPH C<lll"llyn Westhoff, 11110, Ml< Director dl family l'lonnlng and Preven!iveServ!l;e•, Sarah llilling:hurnt Professor dl Reproductive Hea~h, Col!lmbia unhlersity Janetv®ng, Ml) Cadlion CHnit1 Vijrginfa TethCatilion School dl Medldn" COP Patient Safety Committee CO,CHAIRS Ed S..ptim11s, MD TW~as A&M Health Science Center Hospital l'<lrmanente Kendall Webb, MD, FACEI' IJnlversfty of Florida Health Systems; Unw.,rslty of Florida Health Jacksorw!lle (UfHll Albert Wu, MD MPH FACI' Bloomberg School of Pubi it: Health Donald Yealy, MD, FACE!> Unive"'ity of Plttsburl!h-O..partmmt <>I Emergency Yanling Yu, l'hD Patient ol A!rn!rlta lone Thraoo, PhD, ACSW Utah Oepartn,ent of Health COP Primary Care and Chronic: Illness Committee CO-CHAIRS O..l" llrateller, 00, MPH Center Patient on be!'llilf ol Creaky Joints Hospital/Columbia University Medical CO-CHAIRS Thlru Annaswamy, MD, MA Center Thomas Mdl1<lmy, 11110 American Ac~my dl Pediatric~ Dallas VA Medlc111 Center Rocheste:r US COPO Coalition Arnir Qaseem" MD~ PhD, MliA American College oll'hy~iclans Philadelphia lind•">' Botsford, MO, MBA, CMQ, Charlotte Alexarn:ler, 11110 Memorial Hermann Medical System laura Ardizzone~ BSN, 1\ilSt OOP, CRNA, ACNI' Memoriol Sloan Ketteriflg Cancer Center Melissa O..mOI'th, !lA The teaplr<Jil Group t~"' Edelstein, MPH, lNHA Ullee Gel!n<~S, MSN, RN, FMN CH!l!STUS Health John James.• I'M> l>•ti"nt Safety America Stephen Lawless, MD MBA, FAAP, !'CCIIII Nemoors Chlldrens Health Sy<tem li£<1 M<:Giffert Consuml!rs Union SuliM Moffatt-llru!l>!, MD, PhD, MilA, FAC$ Ohk> State University'~ Wexr>er MEMBERS Kenneth l!<Jnson FAAFI' $ug<~r creek- Memori<l! John Am•rham, MBA T<ust for J\n'<!rica's He~lth Washln81on Jkt 247001 Hermann Hmlthcare System Tamala Bradham, DHA, PhD, CCC-A vanderbilt Univernity Moo leal Center Rog.,Choo Oregonl1!1!altll & :>thence Unlver$ity Wo<>dv l'!setlber>t, 11110 Mimaclllaer, MD Nmett<' llenbow, MA Northw.,•stern Unill@rsi!y Illinois Man<~ged Care Coo$ ulting, LLC Kim Eliott, Phil Ron 111"1<!1<, MPI', tQ.IA J. Emilio C.mllo, MD, MPH !lew York-Presbyterian, Weill Cornell Medical Co!l<!i!e llal1'\l·l.,;s Harris, !i, MO Common T•ble H<'!alth Alliance Catherine Hil, DNI', AI'RN Texas He•lth Resour<es Scott friedrnatl, MD Florida Rellna CoMultanls Wllliaml!nmdle Glomb, MD, R:CI', FAA!> Superior Healt!\Pian ll<>Ml<IGo!<llmnn, 11110 Hilrvard Medltal School J"fi""V Hart, MS Ronald !nge, DDS Delta Dent•! dl Missouri Kais-er Perma:nente l'atrioa McKme, DVM, MPH MlehlganO..portment of Community DallidLmg,MO Cleveland Aflne Leddy, 11110, FACE Medical Center 18:47 Jun 25, 2019 Kelly Clll'/tlm, MPH MEMBERS C11rtis: C<>ii!M, l'harmtl, MS Heollh System Olristt>pher Cook, Ph arm D., PhD jbell on DSK3GLQ082PROD with NOTICES Georgmowtl Univernity Steven Teotsdt, MO, MPH University ol California . Los Angeles and Uniwr>fty of Southern Calilo rnia Arjun lfenl<etesh, MD, MilA Vale UnivernitySchoolofMoobtiM COP Prevention and I'Oif>Uil~l:I<~•n Health Committee MEMBERS VerDate Sep<11>2014 Mlmael Stoto, PhD Glou~ester-Mathews Free Clinic PO 00000 Frm 00107 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.077</GPH> Cor~Joration Malt stiefet, MPJI, MS Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices Ridn;rd Mlldonna, 00, MA. MAO SUNY Collage of Optometry M\lra Kleinpeter, MD, MPH School ol Medicine .John Mdlay, MD 30189 John Handy, MD Arnelicon Co!teg<! of Chest l'hyslcians Mark !arret!, MO, MI.IA Peclla!ri<$ Dl!inlel Mm>enstein, MD Health System Mlilhesh Krishnan, MD, MPH, MBA. Oiffom K<l, MD, MS, MSHS, FACS FASN An1<.rkan Collell" of S~Irgeons/UCLA Georgetown UniW~nity Medi<:al Center Ridtwd KMurrll'f, MD Merck and Co. In<. {Ratired), Fellow Harvard Advancad Leadership ln~iative Andrew Sd!adtat, MD Cole Eye Institute Mich...,; Stewart, MD, MPH Weill Cornell Medical College William Taylor, MD Atrius Heai!h Kimberly Templeton, MD Telligen West Barbara il!llll, MD, FACOG, FACS American Co!lel!" of Obstetricians and Gy"'"'ol"!!ist!l !larry Markman, MD Franklin Maddul<, MD, FACP Aetna OaVita Health care Partners .• li"" lalt!J, MD, MSI'H, MBA, FACP Universtty of CA Health Plan Oenv.:lr Karilynne lennln~~t MHA, LIISW Fresenius Medical Care North Arnerka lawrence Mo!is., MD Andrew NliNa, MD, fACP, FASN Nationwide Children's Hospital National Institute of Diabetes and Oigestiw Kidney Oisea<es -Natiooal .Amy Moyer Universftv of Kansas Medical Cal\!er Institutes of Health Keith Olsen, PharmD, R:CP, FCCM Adam Th<lfllps<m, !!A .le>sie Pavlln~, MS, RD, CSR, lD Northaasl Caribbean AIDS Education and Training Ce!\!en Kalble<'ll'l YMemdtuk, MD, MSA The Alliance Fitchburg. Medical Uniwrsity Mark llutkowsl<l, MD California Permonente Medical Group Mich!!el Somers, MD lynn Reede, Dill!', MilA, CRNA Nurse H"rvard Medtca!Sdwcl/Soston COP Renal Committee Hospital llobbi Wqer, MSN, RN Salvatore T. Sadi, MD Kidney Constanre Anderson, BSN, MilA Northwest Kidney Centers l'!!tie!'lts lorien Dl!ilrymple, MD, MPH John Wagner, MD, MilA F!es.,ni~~S Medkal Care Norl:h Arnerka Kine:; Counl;ji Hospital Cent..r Joshua Zaritsky, MD, l'hD Nemoors/A.I. duPont Hospital fui' Children lsllir llhan, MD, MPH Massachusetts Genera~ Hospital Raiesb Dilvda, MD, MBA, CI'E Cigna He.althcare Elizabeth Ev'''"· DNI> Center COP Surgery Standing Committee Melissa lboma.oo, MS, PMI' Vident Health llamee Whitaker, PhD CO~CHAIRS Nurs<:s Association Mldtael fisdt'l!r, MD, MSPH Dl!ipartment of Veterons Affoi" tee Fla•her, MD Renee G•rick, MD, FACI' Renal Westches!er Mlldi!:al Center, New York William Gunnar, MD, JD A.J. Yates, MD Dllpartment of Orthopedic Sur8erv. University of Pittst:.Jrgh Medical Center Veterans Health Administration T eMII'fa Eeten Medical Collage Haw!llome Swwt&Ynstein, MD Monte!iore Medital Center Bmn~ Mil<e Guffev Karl llilimoria, MD, MS Northwestern University Robert Cirna, MD, MA UMB&ank Ridtard Dutton, MD, MilA United States An.,.thesia l'artners Ell$abeth &<!!<son, MD, MPH Geisel S<;hool of Medicine Dartmouth Httchccd: Medical Center Soci<!ty of Anestb!\l!lio!pgists Dl!ibra Hain,I'I>D, AI'RN, ANP·BC, GN!L BC,FMI\IP Anl@rkan Nephrofogv Nurses' A<So<:latl<:>n jbell on DSK3GLQ082PROD with NOTICES Lori Hartwell Ren•l Support Network Fredwick Kasl<el, MD, I'I!D at Montelior<! VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Medicaid and CHIP (MAC) Scorecard Committee MayoChnic COMMITTE£ CO-CHI\IRS (VOTING) Harold Pinrus, MD Columbia University Ridt«<l Jlntam•lli, MD lloston Children's Hospital Ff<':dvid< Gra~~er, MV University of Colorado School of Frm 00108 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.078</GPH> MEMBERS Unlllerslty of Fiorl<:!a·Gaines'<llle Allan Siperstein, MD Cleveland Clinic Josi>Uiil D. Stein, MD, MS University of Michigan lari..a Temple, MD Memorial Sioan~·Ket!~rlng Cancer 30190 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices ORGANIZATIONAl MEMBERS (VOTING) Common formats fur Improving Attribution Models Advisory Panel MEMBERS Data Expert Panel Ateev Mllhmtra, MD, MPH OwldC a-oo, MD, MS Sthool of Medicine Henry C.L Johnscm, Jr., MD, MPH Arnericiln Occupational Therapy Asso~iation Oeniel!e Uovd, Ml'H lor Commtulit'f .Affiliated Plans (ACA!'j Henl)l JooMon Healthcare Consulting Premier llC Jennifer !>e.rloff, PliO SciJ:m!lst Human Services Reear(h Institute Intermountain Health Debra llaketilan, 1'110, MSN, FNP RrarKl@iS Unht@fsity Settv Irene Moore School of Nurning at Brandon 1'<\PI', PliO Aetna Medicaid Baylor Scott & While Qual~y Alliance /lf'ft@'r1can NuNi@S Assoc[atton (ANAJ Anthem Indiana Medicaid Jadllle>ned<, MD Professor The JOint Commi~slo!'t Unlvet$lty of California Chl!dren's Hospital Association !CHA) National AssociatiOn of Medicaid John II. Clarke, MD, FACS Univernlly College ol M<'>dicine Srinivi!> Sridhar.,, Pho, MS The Advisory lloard Company Naoey E. Oon<o!dson, RN, DillS<, FAAN L Oeniel Mllldoon, MA Nur.ing "''""xiaticm of Pediatric Nune PractitiOner~ Rim !ltd 1'. Dolton, MO, MilA famili!ls P..ts L Elkin, MD, MACP, I'ACMI (NAPNAP) Nationall'arll'lership for Women & Mercy Health Chesterfield Medical Center M<>tthew Grissinger, IIPh, !VIS, FISMl', fA.SHI' ln~tltute for S!tfu Medication P ractlces lindsay Cogan. PhD Camille Dobson, MPA David Einzig, MD Sooali De.,;, Mo, MPH Brigham and Women's HospJt.al Boston, RldlOI'd Roberts, MO, JO Kaiser Permanents Arthur Levin, MPH Centerfor Medical consum<lr< Kim Elliott, PhD, CPHO. S..ll!!v!lle family M<!dicim• llellevill" Lori A Paine, RN, MS AmyHoutrow, MD, PhD.. MPH urmim.,la Sarkar, MO, MPH The Johns Hopl<ins Hospttal University o! California, San francisco shannon Phillips, MD, MPH, FMP Cle~~eland Clinic He..tlloer II. Sh,.moo, PhD Olli:lllrtment of Medicaid SUBJECT MATTER EXPERTS (VOTING) MHS MPA MEMBERS P..t:M 8ra-r, PhD Helen !.au, RN, MHROO, I!Sl\1, I!Mus S"'y!lam Kuy, MD, MHS,, FACS Stephen Law'less, BS, MD, MBA, FAAP, FCCM,l'SMI> lullatggan, MD Anesthesia Q1.1ality lnstitll\e ~nd the H>ealth Syst.em Dover Owid C. Stocl<well, MO, MBA Children's Nlrtional M~dical cenler Saul W"ln.gart, MO, Ml'l',, PhD jbell on DSK3GLQ082PROD with NOTICES Tufts Medical Center Boston Brendan Loughran, MA Centsrs for M!!cllt:ars & Medicaid VerDate Sep<11>2014 uco..vis G<!rard M. Castro, MPH VTEADVlSOR lliml!l'd H. White, MD Jeff Schiff; MO, MBA Sen.ric@s Marissa Schfeiler, Rl'h, MS Barbara~~-""· MO, MPH Ag<!ney Judy Zerran, MD for Hea!!h<:are Resea«<h and Quality 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00109 Fmt 4703 Sfmt 4725 Unlwrs!t~ of Califoml• E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.079</GPH> Association Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices 30191 Appendix C: Scientific Methods Panel Roster CCI-CHAIRS Owldtell.., Pht! Northwestem Uniw"itV tlwld N<ll'tlM, !'110 Crrector, C<!ntl!r for H.,.l!h Policy and Heolth S<!fl!ices ltMordr, H<!nf\1 Ford H~olth System MEMBERS J. MattAm;!ln,l'hO Assistant Prof.,.sor, Annstn:mg lnstttute for Patlrmt SME!ty &nd Quality •tJohM Hopkins Medicine Bijm Borah, MS<:, PliO Associat@ Professor, Ma:yo Clink lolln !!ott, MBA, MSSW Mana~~"'• Hea!thcore Ratings, CortSumer Reports lacy fabiM, PhD Lead Hea!thcare Evaluation SP<!Cialist, The MITRE Corporation Maryl>eth fwquhar, PhD, MSN, R.N Vi<e !'resident, Quality, RI!S!Io rch & M easuremoot, Jeffrey G<i'!ll>ert, EdM, 10 l1!ader, llatt~ll<! Memori<rllnst~ute l':aul<ierrard, !IS, MD Director Physical Medicine and l!el.,b·ilillirtic•n, New England RehabilllatiM H""pllakl of Portland (Helll!hSooth, Inc,) laurent GIW'!ce, MD Professor and Vit~Chair lor Research, University of Rochester School of Medtr::lne and Dentistry Stephon Horner, 111\1, llSN, MilA Vice ?resident Clini<•l Analy!:ics, HCA, Inc. Sherrie KapiM, PhD, MPH Professor of Mecltr::ine, \lite Chance lim' lor Healthcare Measurement and Evaluation, UC Irvine 5thoo! of Medicine Jooepl'r Kuni'!d'l, PhD, RN-BC, CPHQ Ent@rprise Oir!!ctor of CUnicai {~,.ua:Hty h'lforma:Uc:s 1 Memorial Hermann Heatth Systern Paul Kurlansky, MD Assodat" Professor of Surgery I Associate Director, Center lor lnnova!i<m •n~ Outco""'s Research/ Director of R"'e•rch, Recruitment and CQ!. Columbia Unive,oty, College of Physicians and Surgeons/ Columbia HeartSomce lhenqiu l.ln, PhD Director of eeta Manaf<!men! and Afllllytics, Yale·New Ha~ten Ht:>Spital Karl!ll t!Wnt Mad®Jt, MO, Ml>!i Assistant Professor, Washin~~ton University School of ledk N""dleman, PhD £1111""" l'ittaio, PhD Prnfelsor, University Jennifer Pel'loff, l'hO Sci<!ntist Deputy Oir<!ctor at !he lnstitut" of Healthcar" Syst.,ms, !lr;;md,is University ""r! Sam Sin1oo, l'hO Senfor ~esearcher, Mathematic• Pol fey Research Mlma<'l Sl:oto, PhD Prnfe>sorof Health Systems Admini>trotion and Popu!atfon Health, Georg..town University Christi" l"ig!Md, PhD \Ike President, Advanced Analytic>, Ava!""" Health Ronald Wiill:ers, MD, MilA, MH~, MS Associate Vice l'r.,.ldent of Medical Operations and Informatics, University of Texas MD 1\ndem>n Canc.,;r c.,nter VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00110 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.080</GPH> jbell on DSK3GLQ082PROD with NOTICES So""" Whll<~,l'lltl, RHIA, CHDA The James Cancer Hospital at Th~ Ohio Slate Univers~v We~ner 30192 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices Appendix D: 2018 Activities Performed Under Contract with HHS 1. Recommendations on the and Priorities Description Improving !lttribution models Exploration of key attribution challenges and key a:>nsiderations for evaluating attribution models Completed Improving ac:cess to hea~llcare in rural populations Provides multlstakeholder recommendations fur a core $et of ruraf .. relevant measures Completed Assessing patient safety in ambulatory care settings Provides multistakehokier recommendations on a representative sample of ambulatory c'!re patient safety measures and measure roncepts Completed An environment<~! sc<~n ol Final report publl>hecl August2018 fln~l report published June 2018 Completed measurement stratil!gies lor addressing tr..uma care recommendations to address the low case·volume challenge faced providers report expected June Provides multistakehokier 1019 recommendattoM to assist ill assessing heallhcare svstem readiness to ensure the sustained delivery of high-quality care during times of disastei'S <1nd public heal!h emergencies, Provides multistakeholder recommendations onquali!y measures for the MAC Srorecard's state he<rl!h performance pillar Medicaid and CHill {MAC) Scorecard Exploration of approaclui!s to measure feedb<JCk Provides multistakeholder rewmmendation on the implementa!lon of • 'measure feedback loop', a process that CotlVii!VS information about measure performancii!{Quatilatlve and quantitative} to multistakeholder groups ev<!luating mea$ures Evaluation of tM NQf Trial Period risk adjustment of social risk findings and lessons leillrned on key themes identified when reviewing rtskadjosted measures for e.ndorsement or mai11tenanc.e, with a special focus on factors scientific acceptability validity) final report expected September 4019 final report expected fellmary 2020 In progress final report publtshed May 2021 reliability and VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00111 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.081</GPH> jbell on DSK3GLQ082PROD with NOTICES 61 30193 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices 2. Quality and Efficiency Measurement Initiatives Co1noJretErd in 2018 safety Cardiovascular Conditions fall Set ol endorsed measures lor 2011 cardiovascUii!r conditions Patient Experience and Function fall2017 Set of endorsed measures for care Prevention and Popu~at~on Completed Final report published August201S Completed Final report published August201S Completed Final report published August 2018 Completed Fmal report published Autust201S coordini!tlon Set of endorsed measures for prevention and populatiOn health fa!I20l7 Endorsed measure fur surgical pro~edures Started In 201.8 Description Output Status lllotes/Sd!<!duled or Actual Completion Date All-Cause Admissions and 'Spring 2018 Set of endorsed measures lor all-cause admissions and readmissions in progress Final report expected January 2019 Behavioral Health and Substance Set of endorsed measures for behavioral health In progress Final report expected January 2019 Cardiovas.::ular Spring 201S Set of endorsed measures for cardiovascular conditi<:ms In progress Final report expected January 2019 Cost and Efficien<:y Spring 201S Set of endorsed measures for cost and In progress Use Spring 20Hl resoun:.:e use Patient Experience and Function Spring::tOlS Set of endorsed measures for patient Prevention and Population Health Spring 2018 Set of endorsed measures lor preventiOn Primary Care and Chronic Illness <;rwiM70UI Surgery Spring 2018 and All·Cause In progress Final report expected J~nuary "2019 experience and function In progress Final report expected Jarm<>ry 2019 Set of endorsed measur"'s for primary care and dlfollic illness In progress Final neport expe~ted Jan11ary 1019 Set of endorsed measures for sur glcai procedures In progress Final r~Jport expected Set of endorsed me<~sures for atka use In progress Final report expected September 2019 In progress Fina! repott expected and population l>eallh 'OH~O' admissions and Pail2018 Final report expected Ja"""IY 2019 C &V<~ !lellavtoral Health and Substance Use fall2018 Set ol endorsed measures for behavioral Cancer Fa!! 201!i Set of endorsed measures for cancer care In progress Final report expected September 2019 CordiOvascuiar Fall 2018 Set of endorsed measures for cordiovascular conditions In progress Final report expected September 2019 Cost and Efficiency Fa!l2018 Set of endorsed measures for cost and In progress Flnal report expected September 2019 In pr"l!re« Final report expected September 2019 In PfOl!f!!SS l'lm•l report expected September Z01!1 c2019 health resource use G<matric and Palliative Care Fall Set of endorsed measures for geriatnc 2018 and palliative c:are Patient Experience and Function f<oll201ll Set of endorsed measures for patient experience and function VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00112 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.082</GPH> jbell on DSK3GLQ082PROD with NOTICES 62 30194 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices Patient Si!few fall lOll! Output Status l'<otes/Sdleduled or Actual Completion Date Set of endorsed measure> fer patient safety In progress Final report expected September 2019 for primary In prOjlress rem~! In progress Final report expected September 2019 In progress Final report expected September 2019 Set of endorsed measures for conditions Set of endorsed meawres lor surgical Surgery Fall 2018 procedures 3. Stakeholder Recommendations on Quality and Efficiency Measures and National Priorities Description Output Status Measure Partnership rule making r;ecommendations on Completed February 2018 Completed Comple!ed February 201!! con!Sldr~ratfon Notes/Scheduled or Actual Compkltion Oatil by HHS Measure Applications Partnership pre· ruiemaklng recommendations on measures under consideration by HHS for 2018 n.~!emaldngfor the hospital setting Conslderlltions lor imp~menting measures in federal programs for post-acute care and long-term care Measure Applications Partnership prerulemaking recommendations on measures under consideration tv HHS for 2018 mlemaidng for the post -acute care and hospital se!tlngs Completed Measure ApplicaUons Partnership prerulemaking recommenda!lons on measures under consideration by f!HS lor 2018 rulemaklng for the clinldan setting Completed Complet<ed M~rch 2018 Measure Applications Partnership Completed Augost201l! Completed Completed August 2018 Allnual i11Pllt on the Core Set of Health Care Quality Measures for Adutts jbell on DSK3GLQ082PROD with NOTICES Measure Applications Partnership input on the core Set of Health Cllre Qu~lity Measures for ChHdren enrolled Medicaid, VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00113 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.083</GPH> Enrolled in Meclica!c! 30195 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices Appendix E: MAP Measure Selection Criteria The Measure Selection Criteria (MSC) ;;re intended to ;;ssist MAP with identifying ch;;racterlstics that are asl>ociated with ideal measure sets rules; rather, they are to complement program,specific statutory "'"~>"rt•nn guidance on decisions and to regulatory requlttlments. Central focus should be on the of high-quality measures that optimally address the National Quality Strategy's critical measurement gaps, and increase alignment. Although competing aims, fill often need to be weighed against one another, the MSC can be used as a reference when evaluating the relative strengths and weaknesses of a program measure set, and how the addition of an individual measure would contribute to the set. The MSC have evolved over time to reflect the input of a wide variety of stakeholders, To determine whether a measure should he considered for a specified program, the MAP evaluates the measures under consideration against the MSC MAP members the and an'~ expected to familiarize themselves with a measure under ~"'"'"""'~"''""ttnn them to indicate endo,rseme!nt criteria, qcceptobi/fl:}l of meqsure properties, feasibility, including importance to measure ond report, usability and use, om:J harmonization of competing and related measures Subcriterion 1.1 Subcriterion 1.2 Subcriterion 1.3 2. Yrrtnnmn measure set lWil'!al,WlEIIJGrldrEJ•<;•;l~~ each National alms Demonstrated o program measure {NOS) aims and corresponding priorities, The NQ$ provides a common framework for focusing efforts of div~~:rse stakeholders em: Subcriterion 2.1 Better care, safel:)l,, and coordination, Subcriterion 2.2 Healttw peaple/healthv communities, demonstrated by prewntion Subcriterion2.3 Affordable well-being measure set is 3. DemotJStrated by a program measure set th(Jt is •fit for purpose" jo1 the particular prog1am Subcriterlon 3.1 Progmm VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00114 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.084</GPH> jbell on DSK3GLQ082PROD with NOTICES 64 30196 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices Subtriterion 3.2 Subcriterion 3.3 Suberiterion 3.4 Suberiterion 3.5 4. Demonstrated by a program measure set that includes on appropriate mix of process, outcome, experience cost/resource use/appropriateness, co,mt:•ostte. and structural measures necessary for the specific Subcriterion 4.1 to measure In Subcriterion 4.2 Subcriterion 4.3 5. services Payment progmm measure sets should include outcome measures linked to cost measures to capture measure set enables measurement Demonstrated by o progwm measure set that addresses access, choice, sel{determination, and community integration SubcritJ?rion 5.1 Subcriteriol! 5.2 Subcriterion 5.3 VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00115 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.085</GPH> jbell on DSK3GLQ082PROD with NOTICES Demonstrated by a program measure set that pramotes equitable access and treatment by considering healthcare disparities. Factors include addressing race, ethnicitv. socioeconomic status, language, gender, sexual orientation, age, or geographical considerations urban vs. rural). Program measure set also can address populations ot risk for healthcare disparities people with behavioral/mental illness}. Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices 30197 Suberlterion6.1 Demonstrated by o program meosure set that supports efficient use of resources for data collection and reporting, and supports alignment across programs. The progrom measure set should balance the degree of effort associated with measurement and its opportunity to improv·e quality. Subcrite.rion 7.1 VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00116 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.086</GPH> jbell on DSK3GLQ082PROD with NOTICES Subcrlterion 7.2 30198 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices Appendix F: MAP Structure, Members, Criteria for Service, and Rosters MAP operates through a two-tiered strucl:~m? of MAP Coordinating Cr~''""~it1·,~>~> National Quality HHS, MAP's workgr<::HJPS advise the Coordinating Committee on measures needed for specific care settings, care providers, and patient populations. Time-limited task more focused topics, such as developing "families of measures"-related measures that and populations-and provide information to the MAP Coordinating Committee and workgroups. Each multlstakeholder group includes individuals with content expertise and organizations particularly affected by the work. MAP's members are selected based on NQF Board-adopted selection criteria, through an annual nominations process and an open public commenting period. Balance among stakeholder groups is paramount. Due to the complexity of MAP's tasks, individual subject matter experts are included in the groups. Federal government ex officio are nonvoting because federal officials cannot advise themselves. MAP members serve staggered three-year terms. MAP Coordinating Committee Amerialn Nu"""• A:!saclation !'harm,.,.ut!Qllll'!-$i!ar<h ~ l\lmnufactu!'1mof Amerioo (PhRMA) !lath Bresch White AMGA COMMITTEE CO-CHAIRS {VOTING) Cluwl<ls Kahn, Ill, MPH MM,MS Conwmer$ Union MSSW,M!lA Health Care Service C<li'IJ<I~allon Samuel lin, Federation of American Hooprtals Harold Pinms, MD ORGANIZATIONAl MEMBERS Deook Robinson, MilA, FACE!', CHCQNI The Joint Commissi<lrl Devid Baker, MD, FACP (VOTING) The lMpfrof; Group Academy of Mml"'!ed c...., !'hannaqr le~h 1'\ll'ld•"' New York Presbyterian/Columbia Uni\lersfty MS FEDERAL GOVERNMENT UAISONS (NON-VOTING) Agency f<>< 1-!@altlmi!I'Ol lle..,arch ,and Quality (AHIIQ} Nancy J. Wilson, MD, MPH Cent<!~> faro;..,..,., Cootroland Pr""ention {CDC) Chesley Rid•<>rds, MD,, MH, FACP MGA Marissa Sdllaifer. MS. !lPh 1\imdkare Rl;;hts center Ai't.CIO Joe Baker Shaun O'Brien, JD National AIN..m:e for Carngiving Am<>tk<l's He<lltl! Inan-e l'!<ms Gail Hunt Substitllte; Grace Whiting, JO 1\ajesh National 1\Mociatlon of Medicaid Am<triam IOIIrd of lllmdlcal Spedall:les MD,FACS Direct<>~> Am<>rla!n AC!lld"my of ~amity Phvoiclans SUBJECT MATTER EXPERTS (VOTING) Cent- for Medi<:llm & 1\imdleald SeNlces(CMSj MO.MHS. Offim of the 1\!..tiooa! CO<lf'din<rtorfor Health lnlormatian Te<hnol<>;!Y lONe! MD, PhO,PMP National !lusiness Groop on Health MAP Rural Health Amy FAAF!' Amerialn Coli"!!" of !'hyoidans NSil!"llllt:e Amir Qa-m. MD, l'hO, MHA, fACP Mary Barton, MD Amerimn College of Surgeons Nalioolll Partnership for Women & ORGANIZATIONAl MEMBERS {VOTING) Natloolll C<lmmitt"" f(lf Quality Wlll'l<grc•up Members Brute Hall~ MD, Ph[). MBA, fACS Families Alliant Health Sclutions Amerlrnn He"lthC..re Associ..tioo Erin Ma<:kily, MPH Amerimn Academy of Famll\f Da~id Gilford, MD, MPH Network for lleglooa! Hea!llm>re !'hy5iciOO> lmpn>~tem.,nt chris Queram. MS Arnerican 1\Cllldemy of Physician Assistants Pacific Business GMi.lp on He~~lth MBA Amerirnn Colleg<t of Erne'!lency Physicians Am"ri""' Hospital Associ.atioo MSN Amerimn lllmdiclll As$0d lttion MD Amerimn H<>spitlli AM<>datlon VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00117 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.087</GPH> jbell on DSK3GLQ082PROD with NOTICES 67 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices Geisinger Mealth Health C!U'e Service Cl::wporatton lntl!rm<runtaln Hlllllthtate Mdligao C<!l'lt.,rfor R<Kal Hullh Mnnesot:a C<m!munlty Meli5l.ltement National Assooatton of Rural Health Oini<s National Center for frontier lntermwntaln He!>lthCare MB, MPH Atrium Health (formerly Carolina's He<llti>Care S\l$teml Mtt Scott Furni!.y, l<lmev ewe P•tn~ Coo!iUrners' CHKI<!l:OOK Robert Kru11hoff, JO Keith Council of Mediml Specialty Societies Helenll<lrstin, MO,MPH, fACP (()i'tlmunities National Coondl for Behwioral Health National Rural Health A!.sodetioo National Rural letter cam ....' ilssooation RIJPRI Cmterfor Rural Health Policy An111y!lis Rurlill WiSQJn>in Hulth C""!"'r<tti\11! rrwen Health Anlllytia LlC/II!M Wal::«'>n He<lltll Cnmll'1I'Y SUBJECT MAHER EXPERTS (VOTING) JollnGlille,MS Curtisl-e!'f, MD Melinda Mllflllly, liN, MS Ana Ve!'lolle, FNP, CNM FEDERAL GOVERNMENT UA!SONS (NON-VOTING) Federal Of!lce <lf Rural Health Policy, DHHS/HilSS tenter for M&li<:are and Medicaid ln1>011allon, Center$ for Medicare & MediCaid Services (CMS) MAP Clinician Workgroup Genentem 1\i!others against Medical Error Hel"!'l Haskll!ll, MA He<lltlll'artnen, lne. Susan Knudson Deborah Wheeler Molina Healthcare INDIVIDUAl SUBJECT MATTER EXPERTS {VOTING) Bru"" llog!ev, MD M'fM<::l\ler MEMBERS Amon""' Academy of PediotriB MPH, FAAP Am"ri""" Ass<>clatlon ol Nu""' Practitioners Na!lono! As<oclation of Psvdliatri<: Health SV•tems(NAI'HS) Frank Ghi.,.si, 1'110,, ABPP Dai<~ Sheller, MI'A Mdlael Ha-t, MO, MPH !'r!c Whitaere, MD, FACS le!lile ltln, MD National Coalition for Hospi<::e and Palliativ" Care R.Sean Nursin!l A!Hance for o.tlllltv care RN, NM·BC, FEDERAL GOVERNMENT (NON-VOTING) Premier, !ne. Pittm•n,MPH Ptojed Patli!nt c...., C"nters for Medic""' & Madicaid Servlces (CMSl Pierre Vong. MD, MPH, MS Hatlie, JD Service Employees International Union He<lltll Res<>urca and Se<Vires Administrallon (HilSAl Sar.hl\lofan Girma Alemu, MO,, MPH Marsha Mall!ling MAP Hospital Workgroup INDIVIDUAL SUBJECT MAHER University of Mdligan WORKGROUP CHAlRS (VOTING) Christl~ EXPERtS (VOTING) Gre!l<>l'fAle1<all<ler, l'hD, Rill, FAAI\I Upshaw Travis, MSHHA Memphhl!u!line:>s Group on Health MBA, MHA, Unlv<!!"SIIy of lex• MD Anderson Cancer Cmter CO-CHAIRS {VOTING} Medtrooic-Minimallv lnvuille Therapy Gr<>op MBA DaeChol CentE!<S for Ols""'" Control and Pr""en!lon (CDC! Peter MD, HallyWo!lf ORGANlZATiONAl MEMBERS (VOTING) Elizabeth Evans, ON!> Lee Ftelmer, MD Jad<lordnn II.SeanMorri~,MD Ann Mi'!l'ill SuNivm, MD Llildi>l!\' Wlmam, !!A, MPA FEOERAL GOVERNMENT Ameri"'i!l Assoda!lon of l<ldnev Patients liAISONS (NON-VOTING) Agency for Health"""' Reseatcll and Quality (AHRQ! Pamela Owens 1 PhD Dian" P>!dd<m, PhD, CRNP, fAANP ils<oci<ltion of 1\meric.., Medical Colleges 1\m@ril;!!!l College of Cardiolosv Janis Orlowski, MD, MAC? J. Ch•d Teoters Ameri<"'s bsential Hospitals Cent,.. for Disease Control and Pr-ntion {COC} Daniel MD An1<>ri<::an Hospital ils<od<ltion Nancy faster Cent.,.,. lor Medic•e & Medicaid ServiC!!S (CMSI MD, MPH Amerl""" Colle!!" of Radiolosv O"vi<l J. Seidenwurm, MO 1\mori"'i!l Oceupa!l~>nallher"'>Y ilswdation 30199 Baylor S<:ntt & While 1-!ealth (BSWH) VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00118 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.088</GPH> jbell on DSK3GLQ082PROD with NOTICES M$1\1 30200 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices DUAl BENEfiCIARIES WORKGROUP LIAISON {NON- MAP Post-Acute Care/long· Term Care Workgroup CO-CHAIRS (VOTING) Gerri Uimb, llN, I'll D Pail MulhattS<!n, MD, MHS Centers for Medicare & Medicaid Servioos(CMSl Cootl:rs for Mediear.. & Mlil!lltaid Se!Via!s(CMS) Offke of the 1\ta!:lanlll Coordinlltorfor H<!lllth lnfonnation Tcdl!'lol"l!Y (ONC) MI5,MBA,RN Force MATTER Richard Antonalli, MD Const""<:e Dahlin, MSN, ANI'-IIC, ACHPN, FPCM, I'AA!\1 Caroline fire, 1'1:10, CPH ORGANIZATIONAL MEMBERS ORGANIZATIONAL MEMBERS {VOTING) Eug""" Nu<rlo,I'I!O Ashi<h Trivedi, !'harroD AMOA-TheSoddyfor !'<>st-Atute ll!ld long-Term Care Medicine Oheen>J Mal!ajaf\, MD, fACPCMO. etC, CliCQM Thorn"' Von ~nb..-g, MD M>erican ~latria S<ldety Debra S.lrba, MD, MI'H (VOTING) MAP MediCaid Adult Task centene Corporation Michael Monson Compassus Kurt M"rk<>ls, MD En<ompass Health (formerly Hea!thS<iuth O:.rporatioo) Lisa Charbonneau, MS CHAIR (VOTING) Harold Pincus, MD !VOTING) 1\!al:!anlli Rural Helillth Ass<>datlm Diane C.fmus, JO Centme Corporatim Maryl(ay Jon,.., MPH, !lSN, RN, Cl'HQ Ameri01:1n Assl><iation of Nurse Practitioner< Sue Keru:lif. JO, WHNI'-BC, FA!INP AsS<>ciatiM for Commtmity Affiliated Hellil:hl'l>~ns Natiooal Partnership for Hospice Innovation MPP Natioolll l'rll$sure Ulcer Advl<orv Panel Arthur Stone, MO, CMO Nationlli Trans;itiMs of Care Coalition Assoda!:l(lll f<>t C-nlllllity Affiliated Plans RN, M!IA,JO Amv Rich•rd«>n. MO, MeA Centene Corporati(lll ArlYf Poole-Yaeger, MO Children's Hocspitlll k<$OOalioo Andrea Be:nin, MD Natimal As•ooation of M<!dlcaid llirectorn !!ache! l• Croi;<, Ph[) Oaborah lGistein, RN, MBA, JD National Partners;ihlp for W-tm and Natlanlli Ass<l<ia!:lm of M<!dlcaid familie~ Directors Carol S$kela, l'hO, MSPH R~hei l'alimt-c,.,moo Prim!II'Y c..,.e La 1'1:10, PMP Jlmeriam A!:a<lerny of family I'I!V>!dans Families USA Ameria.n A<.ademy of Pediatrics Terry Adirim. MO, MPH Ameri01:1n Nurses Ass<>dation Gregory Craig, MS., MPA llmeti<»'s !'ssenlial H<>spltlll< Kathtyn ll<l!!tlie, MD Amtlri<:an Academy of Famil\1 l'l!ysicill!l< l!oan!le Osborne-Gaskin, MO, MiliA, Force MEMBERS .American Oo:upationallh !ll'l!P\f Asst>cla!:l<>n Pamela Rob,rts, PhD, OTR/l, SCf ES, CPHQ. fAOT!I M>eriG~:~n l'l!ysi<al TherliP\( Association H..,.ther Smith, PT, MPH CHA1RS {VOTING) EXPERTS {VOTING} Ril<kl Mll"ll!'um, Ml5 Ameriean A>:ademy of l'l!yskal Medicine & Rehabilltlrti<lll MAP Medicaid Child Task Collaborative Consortium for Otilens with Disabllitl&s Clarke !loss, O!'A Academy of Managed Care l'l!armacy Marissa Schfaifer, Rl'n, MS MAHER EXPERT MEMBERS {VOTING) Kim lilliot, 1'110, CI'HQ fEDERAL GOVERNMENT MEMBERS FEDERAL GOVERNMENT (I\IONNOTING, EX OFfiCIO) Agency for Heat!hmre Researd> and Visiting Nunes Ass.aciation of America MEMBERS Quality Daniell<! Pierottie, RN, PhD, CENP, AOCN,CHP!'I (NON-VOTII'JG, EX OFFICIO) Kamila Health !le«>ur<:"" md Set\lices Adminis'll'ation (HRSA) Nair, M!>,RO Centm; fur M~dltar" 1l< Medicaid Jame. lett, MD, CMO FEDERAL GOVERNMENT UAISOIIIS {NON-VOTING) C<!llt<n f<W Meditilf<! & Medicaid Servl.;es(cMSl MD PhD, MI'H Sentices Mf'H, FMP SUb>tance Abuse !ll'ld Ment"l He<llth Setvl<:i!s Administration {SAMHSA) 1'1!0 Health hsollr<:"" and Services Administration RD VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00119 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.089</GPH> jbell on DSK3GLQ082PROD with NOTICES 69 30201 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices Appendix G: Federal Public Reporting and Performance-Based Payment Programs Considered by MAP 3. Ambulatory Surgical Center Quality Program End-Stage Renal Disease Quality Improvement Program (ESRD QIP) Home Health Quality Reporting Dm.or~,m• Quality Reporting Program Hospital Acquired Coml!tfon {HAC) Reduction Program (HACRP) Hospital inpatient Quality Reporting (IQR) Program and Medicare and Medicaid Promoting lnteroperability Program 7. Hospital Outpatient Quality Reporting (OQR) Program B. Hospital Readmission Reduction Program (HRRPI 9, Hospital Value-Based Purchasing (VBP) Program 10. Inpatient Psychiatric Facility Quality Reporting (IPFQR) Program Inpatient Rehabilitation Facility Reporting Program Care Hospitaf Reporting Program Memcare Shared Savings Program 5. 6. Incentive Payment Pm~n.,,ctil'"" Payment Nursing Facility Quality R<"r>r>rl·in~ Nursing Facility Value-Based Pm·,-.h:nir'" Hospital VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00120 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.090</GPH> jbell on DSK3GLQ082PROD with NOTICES 70 30202 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices Appendix H: Medicare Measure Gaps Identified by NQF's Measure Applications Partnership irl••ntffiP•rl the following measure gaps-where high-value hf'«"""'e and Enct-s:ta!<e Rena Disease Quatity Incentive Program (ESRD Qlf') • PP""Exempt Cancer Hospital Quality Reporting (PCHQR} Program • Ambulatory Surgery Center Quality Reporting (ASCQR) Program Measures that assess safety events broadly {i.e. a measure of global harm} • Pati;mt-teported outcomes • " • • Comparisons of surgical quality across sites of care Infections and complications Patient and family enl!al;;erm!!1l Efficiency measures, including approprlate pre-operatfve testing " " comorbidities Quality of psychiatrfc care provided In the emergency department for patients not admitted the hospital Discharge planning • • Hospital Outpatient Quality Program Assessment of quality of pediatric dialysis Management of comorbid conditions (e.g,, congestive heart failure, diabetes, and hypertension) • Condition-spedlic: readmission measures Communication and c.are coordination Falls Accurate diagnosis Readmissions Reduction Program Merit-Based Incentive Payment System {MIPS) • Patient-reported outcomes Dementia • None discussed • None discussed " " Adverse drug events Surgical site infections in additional locations .. Composite measures to address aspects of care quallty Outcome measures Measures that allow a brood rangeofdlnidans to report data • Medicare Shared Savings Program Composite measures to address multiple aspects of tare qu<~lity Inpatient Rehabilitation Fadlity Quality Reporting Program (IRF QRP} • • • Transfer of patient information Appr<Jpriate clinical use of opioids Refinements to cmrent infection measures VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00121 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.091</GPH> jbell on DSK3GLQ082PROD with NOTICES 71 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices • • Sidirection~l measures Efficacy of transfers from acute care hospitals • • Appropriateness of transfers Patient and caregiver transfer experience Detailed adva ncec directlves • Sk!Ued Nursing Facility Value-Based Purchasing Program {SNF VSP) • Home Health Quality Reporting Program " • !HHORP} 30203 to SNFs None discussed M<!'asurl"S that address social determinants of health New measures to address stabilization of activities of dally • Medication manageme.nt at the end of life " Pr0'!11Siol1 of bereavement· services • Effective servioo delivery to caregivers • Safety Quality Reporting Program • Functional status • • Symptom management, i11dud!ng pai11 Psychological, social, and spiritual needs VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00122 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.092</GPH> jbell on DSK3GLQ082PROD with NOTICES 12 30204 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices Appendix 1: Medicaid Measure Gaps Identified by NQF's Medicaid Workgroups Di<n~•·itl••• Assessing and Addressing of Social Determinants Health Maternal and Reproductrve Health and equity focused measures in with soda! determinants of health • lnterconception care to address • Poor birth outcomes {e.g. premature birth) • Postpartum complications • Strpport factors • • Substance abuse " Mental health""'"""""" • Care " Behavioral health • Soda I determinants experience " Maternity cere (including experience • Cost (including finance reform for behavioral " Duration of child health insurance co\11:!rage over 12 • Care coordination breastfeeding) VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00123 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.093</GPH> jbell on DSK3GLQ082PROD with NOTICES months 30205 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices Appendix J: Measure Gaps Identified by NQF Measure Portfolio are too few or non-exfs tent to drive improvement-across topic areas fot· which measures were reviewed for endorsement. Subject areas marked as H2017" are subjects that did not Identify new measure gaps in 2018, or endorse new measures that alleviated existing gaps. All-cause Admissions and Readmissions No Identified measure gaps Behavioral Health and Substance Use (2011) • • • • • " • • • • • Outcome measures for psychotic disorders, including schizophrenia Overprescription of opiates Setting"specific measures (e.g., jails) outcome disorders in the primary myriad mental illnesses measures that and schizophrenia) rather than separate screening measures for each illness Patient-reported Measures that encompass multiple setting$ to better assist the push towards integrated behavioral health and physical health Measures that examine the period of time between screening and remission Measures that address access to behavioral health facilities, thereof Measures that focus not only on treatment and prevention but also recovery cancer (2017) • • • Prostate and thoracic cancer measures that range from screening to advanced disease Oral chemotherapy compliance measures Outcome measures including rlsk~djusted morbidity and mortality measures cardiovascular • Patient-reported outcomes • Patient-centric composite measures Cost and Efficiency • • • • new language to describe existing identified measure gaps) per capita cost for Medicare Measures focused on costs in post-acute care settings including home health, skilled nursing facilities and long-term acute care Episode-based measures that focus on the care acute conditions settings such as the emergency department, and urgent care Episode-based measures focus.ed on high-cost chronic conditions and capture acute exacerbations and events, including diabetes, cerebral vascular disease, coronary artery disease, chronic obstructive pulmonary disease, and dementia Geriatric and Palliative Care (2017) • Screening for depression, anxiety, etc. • Access to nutritional support • Use of decisional conflict VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00124 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.094</GPH> jbell on DSK3GLQ082PROD with NOTICES 74 30206 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices • • Dying in preferred site of death Orders for values • • • • • • • • • • • • • • • • • • • • • • patient (e.g., depression, complicated bereavement, etc.) Total pain (including spiritual Psychosocial health Unmet need (e.g., through Integrated Palliative Care Outcome Scale {iPOSI instrument) Quality of life Goal~concordance Shared decision making Comfort with decisions that are made (e.g., less decisional conflict) Patient/family engagement Values conversation that elicits goals of care parties! Good communication {e.g., prognosis, health literacy, clarity of goals for Unwanted care/care that m<~di!:atiions/lnterventions Symptomatology due to Unmet psychosocial and spiritual need reconciliation Safe medication use and disposal Feeding tube placement dementia patients aspirin, Discontinuation of available interventions in terminal patients (e.g., multivitamins, memory drugs, ICDs, CPR, chemo last 2 weeks) Caregiver support Caregiver stress Good communication (early, open/shared) Patient Experience and Function • Measures that focus on patient stabillz:ation when improvement is • Measures directly related to patient goals versus treatment goals the goal of treatment Patient Safety l2017) • lntencperability of • fn care • Safety in ambulatory surgical of care across and within settings • Measurement focused on • Outcome measures related to medical errors and complications • Greater focus on ambulatory, outpatient, and post-acute care • Assessment of workforce perfonnance • Patient-reported outcomes Perinatal and Women's Health • Overuse, underuse, including physiologic childbirth • Woman~reported experience and outcomes of care • and health plan to align facility measures VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00125 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.095</GPH> jbell on DSK3GLQ082PROD with NOTICES 75 30207 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices Prevention and Population Health 12017; the pro~ct Wi'IS reconfigured from Health and Wll'llbeing in 2017) • Measures that detect differences benchmarks, but also differences • • • • • Measures that assess access to care Measures that assess Measures that address food Measures that address language and literacy {e,g,, health literacy) Measures that address social cohesion Primary Care and Chronic Illness • Ischemic vascular disease evaluation and treatment • " Chronic kidney disease evaluation and treatment (Stage 4 referrals, as an example) Wound care/Wound Status measures " Nutrition/Malnutrition Measures (Screening, Assessment, plan, discharge, etc.) • Additional " Te!ehealth/ Remote Patient • Community Acquired Pneumonia Measures those related to appropriate use of rapid direct treatment prevent antimicrobial '"<:kt:onr·p diagnostic testing • Acute sinusitis Imaging for sinusitis • • • • Functional Status"'"'""""" Measures Complications Depression measures Counsel!ng Accident prevention in children (helmets, seat belts} Accident prevention in adults (seat belt use, distracted driving} Fall prevention in the elderly (exercise) • Quality of Life Renal (2011) • Patient·reported outcomes • Patient experience of care and engagement Care for comorbid conditions • • • Palliative dialysis Vascular Access • Young dialysis patients' preparedness • Rehabilitation of people who • transition from pediatric facilities to adult facilities age measuring bloodstream infections across dialysis and other facilities Surgery • • • Pediatrics Orthopedic surgery, bariatric surgery, neurosurgery, obstetrics, and gynecology Measures that assess overall surgical quality, shared accountability, and patient focus VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00126 Fmt 4703 Sfmt 4725 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.096</GPH> jbell on DSK3GLQ082PROD with NOTICES 76 30208 Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices National Quality Forum 1030 15th St NW, Suite 800 Washington, DC 20005 VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 PO 00000 Frm 00127 Fmt 4703 Sfmt 9990 E:\FR\FM\26JNN1.SGM 26JNN1 EN26JN19.097</GPH> jbell on DSK3GLQ082PROD with NOTICES ISBN 978-1-68248-108-0 ©2019 National Quality Forum Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Notices [FR Doc. 2019–13626 Filed 6–25–19; 8:45 am] BILLING CODE 4120–01–C DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Center for Complementary & Integrative Health; Notice of Closed Meeting Pursuant to section 10(d) of the Federal Advisory Committee Act, as amended, notice is hereby given of the following meeting. The meeting will be closed to the public in accordance with the provisions set forth in sections 552b(c)(4) and 552b(c)(6), Title 5 U.S.C., as amended. The grant applications and the discussions could disclose confidential trade secrets or commercial property such as patentable material, and personal information concerning individuals associated with the grant applications, the disclosure of which would constitute a clearly unwarranted invasion of personal privacy. Name of Committee: National Center for Complementary and Integrative Health Special Emphasis Panel; Early Phase Clinical Trials of Natural Products (R33 and R61/R33) and Natural Products Phase II Clinical Trial Cooperative Agreements (U01) (NP). Date: July 25, 2019. Time: 12:00 p.m. to 3:00 p.m. Agenda: To review and evaluate grant applications. Place: National Institutes of Health, Two Democracy Plaza, 6707 Democracy Boulevard, Bethesda, MD 20892 (Virtual Meeting). Contact Person: Martina Schmidt, Ph.D., Chief, Office of Scientific Review, National Center for Complementary & Integrative Health, NIH, 6707 Democracy Blvd., Suite 401, Bethesda, MD 20892, 301–594–3456, schmidma@mail.nih.gov. (Catalogue of Federal Domestic Assistance Program Nos. 93.213, Research and Training in Complementary and Alternative Medicine, National Institutes of Health, HHS) Dated: June 20, 2019. Ronald J. Livingston, Jr., Program Analyst, Office of Federal Advisory Committee Policy. [FR Doc. 2019–13540 Filed 6–25–19; 8:45 am] BILLING CODE 4140–01–P jbell on DSK3GLQ082PROD with NOTICES DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health Center for Scientific Review; Notice of Closed Meetings Pursuant to section 10(d) of the Federal Advisory Committee Act, as VerDate Sep<11>2014 18:47 Jun 25, 2019 Jkt 247001 amended, notice is hereby given of the following meetings. The meetings will be closed to the public in accordance with the provisions set forth in sections 552b(c)(4) and 552b(c)(6), Title 5 U.S.C., as amended. The grant applications and the discussions could disclose confidential trade secrets or commercial property such as patentable material, and personal information concerning individuals associated with the grant applications, the disclosure of which would constitute a clearly unwarranted invasion of personal privacy. Name of Committee: Center for Scientific Review Special Emphasis Panel; Member Conflict: Pain and Multisensory Integration Processes. Date: July 23–24, 2019. Time: 8:00 a.m. to 6:00 p.m. Agenda: To review and evaluate grant applications. Place: National Institutes of Health, 6701 Rockledge Drive, Bethesda, MD 20892 (Virtual Meeting). Contact Person: John Bishop, Ph.D., Scientific Review Officer, Center for Scientific Review, National Institutes of Health, 6701 Rockledge Drive, Room 5182, MSC 7844, Bethesda, MD 20892, (301) 408– 9664, bishopj@csr.nih.gov. Name of Committee: Center for Scientific Review Special Emphasis Panel; Member Conflict: Auditory and Memory Processes. Date: July 23, 2019. Time: 9:00 a.m. to 5:00 p.m. Agenda: To review and evaluate grant applications. Place: National Institutes of Health, 6701 Rockledge Drive, Bethesda, MD 20892 (Virtual Meeting). Contact Person: Kirk Thompson, Ph.D., Scientific Review Officer, Center for Scientific Review, National Institutes of Health, 6701 Rockledge Drive, Room 5184, MSC 7844, Bethesda, MD 20892, 301–435– 1242, kgt@mail.nih.gov. Name of Committee: Center for Scientific Review Special Emphasis Panel; Member Conflict: Eye Cell Biology. Date: July 23, 2019. Time: 10:00 a.m. to 1:30 p.m. Agenda: To review and evaluate grant applications. Place: National Institutes of Health, 6701 Rockledge Drive, Bethesda, MD 20892 (Virtual Meeting). Contact Person: Charles Selden, Ph.D., Scientific Review Officer, Center for Scientific Review, National Institutes of Health, 6701 Rockledge Drive, Room 5187, MSC 7840, Bethesda, MD 20892, 301–451– 3388, seldens@mail.nih.gov. Name of Committee: Center for Scientific Review Special Emphasis Panel; Review of U01 Collaborative Research Applications. Date: July 23, 2019. Time: 10:30 a.m. to 1:00 p.m. Agenda: To review and evaluate grant applications. Place: National Institutes of Health, 6701 Rockledge Drive, Bethesda, MD 20892 (Virtual Meeting). PO 00000 Frm 00128 Fmt 4703 Sfmt 4703 30209 Contact Person: Raj K. Krishnaraju, Ph.D., Scientific Review Officer, Center for Scientific Review, National Institutes of Health, 6701 Rockledge Drive, Room 6190, Bethesda, MD 20892, 301–435–1047, kkrishna@csr.nih.gov. Name of Committee: Center for Scientific Review Special Emphasis Panel; Member Conflict: Endocrine and Reproductive Biology. Date: July 23, 2019. Time: 11:00 a.m. to 5:00 p.m. Agenda: To review and evaluate grant applications. Place: National Institutes of Health, 6701 Rockledge Drive, Bethesda, MD 20892 (Virtual Meeting). Contact Person: Raul Rojas, Ph.D., Scientific Review Officer, Center for Scientific Review, National Institutes of Health, 6701 Rockledge Drive, Room 6185, Bethesda, MD 20892, (301) 451–6319, rojasr@ mail.nih.gov. Name of Committee: Center for Scientific Review Special Emphasis Panel; Member Conflict: Child Psychopathology. Date: July 23, 2019. Time: 1:00 p.m. to 4:30 p.m. Agenda: To review and evaluate grant applications. Place: National Institutes of Health, 6701 Rockledge Drive, Bethesda, MD 20892 (Telephone Conference Call). Contact Person: Jane A. DoussardRoosevelt, Ph.D., Scientific Review Officer, Center for Scientific Review, National Institutes of Health, 6701 Rockledge Drive, Room 3184, MSC 7848, Bethesda, MD 20892, (301) 435–4445, doussarj@csr.nih.gov. Name of Committee: Center for Scientific Review Special Emphasis Panel; PAR16–275: Adverse Drug Reaction Research. Date: July 23, 2019. Time: 3:00 p.m. to 6:00 p.m. Agenda: To review and evaluate grant applications. Place: National Institutes of Health, 6701 Rockledge Drive, Bethesda, MD 20892 (Virtual Meeting). Contact Person: Alexander D. Politis, Ph.D., Scientific Review Officer, Center for Scientific Review, National Institutes of Health, 6701 Rockledge Drive, Room 3210, MSC 7808, Bethesda, MD 20892, (301) 435– 1150, politisa@csr.nih.gov. Name of Committee: Center for Scientific Review Special Emphasis Panel; PAR 17– 094: NIGMS Maximizing Investigators’ Research Award (R35). Date: July 24, 2019. Time: 8:00 a.m. to 8:00 p.m. Agenda: To review and evaluate grant applications. Place: Residence Inn Bethesda, 7335 Wisconsin Avenue, Bethesda, MD 20814. Contact Person: William A. Greenberg, Ph.D., Scientific Review Officer, Center for Scientific Review, National Institutes of Health, 6701 Rockledge Drive, Room 4168, MSC 7806, Bethesda, MD 20892, (301) 435– 1726, greenbergwa@csr.nih.gov. Name of Committee: Center for Scientific Review Special Emphasis Panel; Member Conflict: Brain Injury and Chronic Neurodegeneration. E:\FR\FM\26JNN1.SGM 26JNN1

Agencies

DEPARTMENT OF HEALTH AND HUMAN SERVICES

[Federal Register Volume 84, Number 123 (Wednesday, June 26, 2019)]
[Notices]
[Pages 30129-30209]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2019-13626]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

[CMS-3365-N]


Secretarial Review and Publication of the National Quality Forum 
2018 Activities Report 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.

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SUMMARY: This notice acknowledges the Secretary of the Department of 
Health and Human Services' (the Secretary) receipt and review of the 
National Quality Forum 2018 Annual Activities Report to Congress and 
the Secretary submitted by the consensus-based entity under contract 
with the Secretary in accordance with the Social Security Act. The 
Secretary has reviewed and is publishing the report in the Federal 
Register together with the Secretary's comments on the report not later 
than 6 months after receiving the report in accordance with section 
1890(b)(5)(B) of the Social Security Act.

FOR FURTHER INFORMATION CONTACT: Sophia Chan, (410) 786-5050.

SUPPLEMENTARY INFORMATION:

I. Background

    The United States Department of Health and Human Services (HHS) has 
long recognized that a high functioning health care system that 
provides higher quality care requires accurate, valid, and reliable 
measurements of quality and efficiency. The Medicare Improvements for 
Patients and Providers Act of 2008 (MIPPA) (Pub. L. 110-275) added 
section 1890 of the Social Security Act (the Act), which requires the 
Secretary to contract with the consensus-based entity (CBE) to perform 
multiple duties designed to help improve performance measurement. 
Section 3014 of the Patient Protection and Affordable Care Act (the 
Affordable Care Act) (Pub. L. 111-148) expanded the duties of the CBE 
to help in the identification of gaps in available measures and to 
improve the selection of measures used in health care programs.
    HHS awarded a competitive contract to the National Quality Forum 
(NQF) in January 2009 to fulfill the requirements of section 1890 of 
the Act. A second, multi-year contract was awarded to NQF after an open 
competition in 2012. A third, multi-year contract was awarded again to 
NQF after an open competition in 2017. Section 1890(b) of the Act 
requires the following:
    Priority Setting Process: Formulation of a National Strategy and 
Priorities for Health Care Performance Measurement. The CBE must 
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-centered 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 across multiple providers, 
practitioners and settings.
    Endorsement of Measures: The CBE must 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 are 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: The CBE must provide for the review and, as 
appropriate, the endorsement of the episode grouper 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; (2) 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 (3) 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 
various federal health care quality reporting and quality improvement 
programs including 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.
    Transmission of Multi-Stakeholder Input: Not later than February 1 
of each year, the CBE must 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 an annual report. The report must describe:
     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 of the CBE's duties required under its 
contract with the Secretary;
     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

[[Page 30130]]

such measures 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.
    Section 50206(c)(1) of the Bipartisan Budget Act of 2018 (Pub. L. 
115-123) amended section 1890(b)(5)(A) of the Act to require the report 
to include the following each year: (1) An itemization of financial 
information for the previous fiscal year, including annual revenues of 
the entity, annual expenses of the entity, and a breakdown of the 
amount awarded per contracted task order and the specific projects 
funded in each task order assigned to the entity; and (2) any updates 
or modifications to internal policies and procedures as they relate to 
duties of the CBE, including, specifically identifying any 
modifications to the disclosure of interests and conflicts of interests 
for committees, work groups, task forces, and advisory panels of the 
entity, and information on external stakeholder participation in the 
duties of the entity.
    The statutory requirements for the CBE to annually report to the 
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 of 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 2018 activities to the Secretary 
on March 1, 2019. Comments from the Secretary on the report are 
presented in section II of this notice, and the National Quality Forum 
2018 Activities Report to Congress and the Secretary of the Department 
of Health and Human Services is provided, as submitted to HHS, in the 
addendum to this Federal Register notice in section III.

II. Secretarial Comments on the National Quality Forum 2018 Activities 
Report to Congress and the Secretary of the Department of Health and 
Human Services

    Once again, we thank the 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 2018 it updated its measure portfolio by reviewing 
and endorsing or re-endorsing 38 measures and removing 40 measures.\1\ 
Endorsed measures address a wide range of health care topics to promote 
value-based transformation of our health care system, and other HHS 
priorities, 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.
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    \1\ National Quality Forum (March 1, 2019) Report of 2018 
Activities to Congress and the Secretary of the Department of Health 
and Human Services, p. 6 (https://www.qualityforum.org/Publications/2019/03/2018_Annual_Report_for_Congress.aspx, accessed 4/10/2019).
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    In addition to maintaining measures endorsement, NQF also worked to 
remove measures from the portfolio for a variety of reasons, such as, 
measures no longer meeting endorsement criteria; harmonization between 
similar measures; replacement of outdated measures with improved 
measures; and lack of continued need for measures where providers 
consistently perform at the highest level.\2\ 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. Measure set refinements also align 
with HHS initiatives, such as the Meaningful Measures Initiative at 
Centers for Medicare and Medicaid Services (CMS). CMS is working to 
identify the highest priorities for quality measurement and improvement 
and promote patient-centered, outcome based measures that are 
meaningful to patients and clinicians.
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    \2\ National Quality Forum, op. cit. p. 18.
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    NQF also undertook and continued a number of targeted projects 
dealing with difficult quality measurement issues. In particular, NQF 
has worked to help HHS address the unique challenges faced by rural 
communities. Nearly one in five Americans reside in rural communities 
and statistically, residents of rural communities tend to have worse 
health status than those living in urban areas.\3\ HHS recognizes the 
unique challenges facing rural America, and with the support of 
partners like NQF, we are taking action to improve access and quality 
for healthcare providers serving rural patients. One of the biggest 
challenges rural Americans face is access to affordable quality health 
care.^{4 5 6} Our reforms in the area of rural health are part 
of our overall strategy to update our programs and improve access to 
high quality services.
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    \3\ Centers for Disease Control and Prevention (January 2017) 
Rural Americans at higher risk of death from five leading causes. 
(https://www.cdc.gov/media/releases/2017/p0112-rural-death-risk.html, accessed 4/10/2019).
    \4\ Douthit, N., S. Kiv, T. Dwolatzky, and S. Biswas (June 
2015). Exposing some important barriers to health care access in the 
rural USA. Public Health. 129(6): 611-620.
    \5\ D. Williams, Jr., and M. Holmes (January 2018) Rural Health 
Care Costs: Are They Higher and Why Might They Differ from Urban 
Health Care Cost? North Carolina Medical Journal. 79(1): 51-55.
    \6\ J. Bhatt and P. Bathija (September 2018) Ensuring Access to 
Quality Health Care in Vulnerable Communities. Academic Medicine. 
93(9): 1271-1275.
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    In 2018, recognizing the lack of representation from rural 
stakeholders in the pre-rulemaking process, HHS tasked NQF to establish 
a Measures Application Partnership (MAP) Rural Health Workgroup. The 
membership of the Workgroup, comprised of 18 organizational members, 
seven subject matter experts, and 3 federal liaisons, reflects the 
diversity of rural providers and residents, and allows for input from 
those most affected and most knowledgeable about rural measurement 
challenges and potential solutions.\7\ With this valuable input from 
our partners and stakeholders, HHS can continue to improve health care 
in rural America.
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    \7\ National Quality Forum (August 31, 2018). A Core Set of 
Rural-Relevant Measures and Measuring the Improving Access to Care: 
2018 Recommendations from the MAP Rural Health Workgroup: Final 
Report, p. 32 (https://www.qualityforum.org/Publications/2018/08/MAP_Rural_Health_Final_Report_-_2018.aspx, accessed 4/10/2019).
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    The Workgroup identified a core set of the best available, ``rural-
relevant'' measures to address the needs of the rural population and 
released a report providing recommendations regarding alignment and 
coordination of measurement efforts across both public and private 
programs, care settings, specialties, and sectors (both public and 
private).\8\ NQF presented the Workgroup's finding on Capitol Hill to 
share this valuable work with members of the Congress.\9\ The Workgroup 
also provided guidance for the Measures Application Partnership to 
ensure that the Measures Under Consideration (MUC) for use in CMS 
programs address the needs and challenges of rural

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providers and residents.\10\ HHS is committed to evaluating our 
measurement practices and looking at them through a rural lens to 
ensure rural providers greater flexibility and less regulatory burden.
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    \8\ National Quality Forum. 2018, op. cit.
    \9\ National Quality Forum (September 17, 2018) NQF Releases 
Report to Improve Access and Health Needs of Rural Communities 
(https://www.qualityforum.org/News_And_Resources/Press_Releases/2018/NQF_Releases_Report_to_Improve_Access_and_Health_Needs_of_Rural_Communities.aspx, accessed 4/10/2018).
    \10\ National Quality Forum (December 12, 2018). MAP Clinician 
Workgroup In-Person Meeting presentation slides #38-43. (https://www.qualityforum.org/ProjectMaterials.aspx?projectID=75361, accessed 
4/10/2019).
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    Additionally, CMS and NQF have worked together to address the low 
case-volume challenge as it pertains to healthcare performance 
measurement of rural providers. Low case-volume presents a significant 
measurement challenge for many rural providers.\11\ Rural areas often 
are sparsely populated, which can affect the number of patients 
eligible for inclusion in healthcare performance measures, particularly 
condition- or procedure-specific measures. Other challenges faced by 
rural residents, such as distance to care or lack of transportation, 
can also lead to low case-volume in measurement. To develop 
recommendations to address the low case-volume challenge for rural 
providers, NQF convened a five-member Technical Expert Panel (TEP) 
comprised of statistical experts and measure methodologists.\12\ The 
TEP released a report providing recommendations to CMS on how to best 
address the low case-volume challenge by incorporating new statistical 
methods into measures specifications.\13\
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    \11\ Quality of Care in Rural Hospitals. (January 2019) Rural 
Health Research RECAP. Rural Health Research Gateway (https://ruralhealth.und.edu/assets/2645-9942/quality-of-care-in-rural-hospitals-recap.pdf, accessed 4/10/2019).
    \12\ National Quality Forum. (October 31, 2018) MAP Rural Health 
Technical Expert Panel Conference Call #1 presentation slides 
(https://www.qualityforum.org/ProjectMaterials.aspx?projectID=85919, 
accessed 4/10/2019).
    \13\ National Quality Forum (April 2019). MAP Rural Health 
Technical Expert Panel Final Report--2019 (https://www.qualityforum.org/Publications/2019/04/MAP_Rural_Health_Technical_Expert_Panel_Final_Report_-_2019.aspx, 
accessed 4/10/2019).
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    Going forward, CMS will continue to work with NQF to strengthen the 
diversity of representation of the MAP Rural Health Workgroup. In 
particular, CMS is taking into account the largely rural nature of 
Tribal and Indian Health Service (IHS) health programs, their unique, 
cultural, funding, and legal status, and their specific challenges in 
participating in initiatives, which rely heavily on the use of clinical 
quality measures. For future NQF calls for nomination for the MAP Rural 
Health Workgroup, CMS will encourage NQF to sit representatives of 
Tribal Nations, Tribal health programs, or Tribal organizations. CMS 
will also reach out to IHS for recommendations of individuals with 
expertise in clinical quality measures and knowledge in health outcomes 
and barriers to care experienced by rural-dwelling Native Americans and 
nominate them as Workgroup members, and IHS staff with said expertise 
and experience as Federal Liaisons for the Workgroup. In addition, CMS 
will ask NQF to reach out to Tribal Nations, Tribal Health programs, 
and Tribal organizations for input during the public comment periods 
for project deliverables.
    Addressing the needs of rural health communities is just one of 
many areas in which NQF partners with HHS in enhancing and protecting 
the health and well-being of all Americans. Meaningful quality 
measurement is essential to healthcare delivery reform, 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 to health care delivery system 
reform. We appreciate the strong partnership with the NQF 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 2018 
Activities to Congress and the Secretary of the Department of Health 
and Human Services, as submitted to HHS.

    Dated: June 7, 2019.
Alex M. Azar II,
Secretary, Department of Health and Human Services.
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[FR Doc. 2019-13626 Filed 6-25-19; 8:45 am]
BILLING CODE 4120-01-C

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