Quality measures must be standardized and aligned across public and private "accountability programs," said Janet Corrigan, president and CEO of the National Quality Forum, in a well-attended presentation at Health Information and Management Systems Society (HIMSS) meeting in Las Vegas this week. "Otherwise, we run the risk of losing the focus of frontline providers," she said.
Corrigan emphasized the importance of quality measures in raising the quality and lowering the cost of care. While providers are currently focused on Meaningful Use, including its quality metrics, she said these will become even more important over the next few years as the government phases in value-based purchasing.
Corrigan explained the key role that the nonprofit NQF plays in evaluating measures that eventually find their way into government programs. This starts, she said, with the national quality strategy required by the healthcare reform law. The U.S. Department of Health & Human Services contracted with NQF to form the national priorities partnership (NPP), which includes leaders of public and private stakeholder groups. The priorities set by this group stress population health management, and NQF is moving in the same direction, she said.
"Over the past 10 years, we have consistently raised the bar" on quality metrics, Corrigan said, as the field has continued to develop. Right now, she noted, NQF is moving from the traditional emphasis on process measures in "silos" like physician practices and hospitals to "process measures in care transitions." In addition, it is looking at functional and quality-of-life measures based on patient-reported data.
NQF also plans to evaluate cost metrics, including the per capita cost of care, total cost of care and out of pocket costs to patients, Corrigan said. A step in that direction was NQF's recent approval of cost and resource use measures developed by HealthPartners, a health plan and physician group based in Minneapolis.
NQF is piloting a quality measure authoring tool to help EHR vendors design software that specifies numerators and denominators for quality reporting, Corrigan said. She added that all NQF-endorsed quality measures will soon be "e-measures" that will have to be reported electronically.
But she also expressed disappointment with EHRs from a quality reporting viewpoint. 'When you develop e-measures, EHRs in the current state do not capture all the data needed for performance measurement."
Over time, she said, the government's EHR certification process may require these applications to facilitate documentation of the necessary data. But at the end of the day, clinicians still have to enter it, and she acknowledged that inputting all of the requisite information might take providers extra time.
Quality measure developers could help streamline this process, she added, by doing things in a more standardized way. For example she said, they could define exclusions from measures the same way to make it easier for physicians.