Stakes are rising for clinical quality: How to get the metrics right

As CMS and private payers accelerate movement toward payment and financial penalties based on care quality, it becomes more important to get quality measures to be the best they can be, according to Christine Cassel, MD, president and CEO of the National Quality Forum.

Dr. Cassel addressed a crowd at the American College of Healthcare Executives annual conference March 16 in Chicago.

She reflected on the recent announcement from HHS that, starting in 2016, 30 percent of Medicare payments will be based on how well patients are cared for, and by 2018 that will rise to 50 percent.

These developments mean "it is even more important — much more important — that we get the measures right." Once we get the measurement right, it can help drive actual healthcare improvement.

However, "too many measures" exist in the industry, Dr. Cassel said, and choosing the right ones will require harnessing data and information and bringing multiple stakeholders to the table to make quality measures more meaningful.

There are several tensions currently in quality measurement that hamper the movement toward a defined set of metrics. For instance, many stakeholders would like to see more use of outcomes measures to gauge quality of care as opposed to "check box" process measures, but patient-reported outcomes metrics can difficult to develop and hard to get data on, according to Dr. Cassel.

Other tensions include measurement burden versus the comprehensiveness of data, system-level measurement versus individual clinician-level management and having a limited set of broad core measures versus having metrics that meet the needs of different specialties.

Building on those tensions, Dr. Cassel laid out the following tasks facing the National Quality Forum and the industry as a whole when it comes to getting quality metrics right.

  • Align measures as much as possible among all payers so everyone uses similar numbers, allowing providers to report those metrics more easily.
  • Identify measures that are actionable, meaningful and lead to better health outcomes — the NQF and others need to "do the research to find out which measures actually help you improve," she said.
  • Achieve greater consistency and rigor in consumer information. She referred to an article in Health Affairs that found national hospital rankings are varied and not consistent. "No wonder consumers tend to ignore all this information," Dr. Cassel said. "It's not really meaningful to them. The question is, what can all of us do together to make the information more meaningful."

Leveraging new technology and big data is a key component of achieving those tasks. As Dr. Cassel said, the healthcare industry has tons of new data available through electronic records and phone apps and other sources. While that data can be helpful, "we do have to have some way to reduce the noise and increase the signal strength of those quality metrics" to take advantage of the data, Dr. Cassel said. "That's the world that I live in. We call it 'measures that matter.'"

One approach the NQF is developing is what Dr. Cassel called "quality measure incubators" in which the NQF will collaborate with big data and social media organizations to develop good measure concept ideas. Then, organizations will serve as "test beds" to try out the measures in a rapid way and, if they are effective, offer the measure up for endorsement and use on a national level.

"We are at a place now going forward in the next five years where we have new science, we have new access to different kinds of data…and we need to be able to make that accelerate," she told the crowd. "I'm going to need your help in making this happen."

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