The Fund-sponsored series of Colloquia on Quality Improvement, chaired by David Blumenthal, M.D., continues to foster action and influence policy by examining salient quality-of-care topics. In attracting leaders from both the public and private sectors, the series of meetings is helping to facilitate exchange of knowledge and expertise, as well as collaboration on projects to address challenges. The June 2004 colloquium focused on the 2003 Medicare reform law, exploring how specific provisions of that legislation could be leveraged to improve beneficiaries' care.

Responding to growing interest nationally in assessing the performance of individual physicians, another Fund colloquium focused on physician clinical performance assessment. Three dozen leaders representing health care purchasers, insurers, researchers, and providers, as well as the American Medical Association and Massachusetts Medical Society, explored why physician clinical performance measurement is important, how to measure quality at the physician level, and what some key challenges are in implementing performance measurement. Dana Safran of the New England Medical Center presented the results of Fund-supported work she conducted with the Massachusetts Health Quality Partnership to validate measures of patients' experience with care at the individual physician level. Safran's project also validated the Ambulatory Care Experience Survey (ACES), which has been adapted for use by the Pacific Business Group on Health, the Centers for Medicare and Medicaid Services' Doctor Office Quality Project, and General Electric's Bridges to Excellence project.

A number of methodological challenges remain to measuring physician performance by valid means. With Fund support, the National Committee for Quality Assurance (NCQA) has formed the National Forum on Performance Benchmarking of Provider Offices and Organizations, a collaboration of health plans nationwide whose mission is to improve the quality of care in provider offices by advancing the methods and practice of provider-level measurement and reporting.

Many sources of information about physicians and their training, affiliations, and quality are already available to the public, particularly through the Internet. But there are significant gaps in the accuracy and completeness of many of these physician directories.⁽³⁾ With a small grant from the Fund, NCQA convened a national advisory group to recommend a set of standards for directories, which were later published by the Fund and NCQA in June 2004.⁽⁴⁾ Fund support to the Midwest Business Group on Health, meanwhile, is testing the application of these standards in the Chicago area in partnership with several large health plans and the Chicago Medical Society.

Aligning provider payments with quality has received a lot of attention lately as efforts are undertaken in both the public and private sectors to provide a business reason for physicians and hospitals to improve quality. With Fund support, the Leapfrog Group developed a compendium that catalogues 78 of these "pay-for-performance" programs nationwide.⁽⁵⁾ But while the number of financial incentive programs is growing, very little is known about their effectiveness and impact on quality. With Fund support, Meredith Rosenthal at the Harvard School of Public Health is conducting an evaluation of the pay-for-performance program implemented by PacifiCare in 2003 in more than 200 California group practices. The study will examine whether aligning payment with standards of care can improve mean performance for 10 quality measures, reduce variation in quality among physician groups, and have a spillover effect on other measures of quality not directly linked to financial incentives.