Step-by-step quality improvement measures can ease ACO implementation

Engelberg Center for Health Reform Director Mark McClellanDespite the huge undertaking that many skeptics say would be required of accountable care organizations (ACO), leaders at Tuesday's Second National Accountable Care Organization Summit in Washington, D.C., said that the long list of quality measures is possible to implement if done incrementally.

When the Centers for Medicare & Medicaid Services (CMS) released its proposed rules in March, many of the likely ACO candidates condemned CMS for the 65 quality measures to be included with ACO performance. Among those measures are surveys, meaningful use, patient experience measures--to name a few--a burden that many smaller facilities and individual providers said would be impossible to collect with their limited resources.

Some argue that quality measurements will serve not only as requirements to participate in ACOs, but ultimately will be the barometer for its success.

"Performance measurement is the cornerstone to accountable care," said Mark McClellan, MD, PhD (pictured), director of the Engelberg Center for Health Care Reform. "Providers need to participate in measurements."

Acknowledging the challenges that go along with massive performance measurements, McClellan said he recognized the significance of using appropriate samplings, accounting for regional differences in nationwide measurements, integrating electronic health records, and providing timely quality feedback to providers.

Peggy O'Kane, MHA, president of the National Committee for Quality Assurance, said about EHR integration with ACOs: "We're asking ACOs to do what they've never done before."

In addition, the healthcare field traditionally has looked at data for a specific condition (e.g., a hip) and not across a continuum (e.g., chronically ill patient populations), according to Richard Bankowitz, MD, MBA, FACP, chief medical officer of Premier Healthcare Informatics. For example, hospitals have inpatient data but may not have data from the ambulatory setting, he said.

The important thing, though, is to start measuring, Bankowitz said. "Measures must matter."

Bankowitz recommended using a starter-set of measurements first, then advancing the measurements along the way. The starter set of data could come from existing data that hospitals already use for pay-for-performance initiatives, such as emergency department visits, admissions, or HCAHPS results.

And what could be the end result of ACOs and quality measures? The perfect example of a successful collaborative model that predates ACOs is, arguably, the success of improving cystic fibrosis care, according to O'Kane. With coordinated care and management between healthcare organizations, providers, and patients, the average mortality age of cystic fibrosis patients is higher today, O'Kane said. That model could be a embedded lesson in accountability efforts today, she said.

Integrated Healthcare Association Executive Director Tom Williams, MBA, DrPH, reminded the Summit attendees, "'A' stands for accountability, and accountability relies on performance measurement."

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