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NCQA Releases Standards for Physician Measurement
The National Committee for Quality Assurance (NCQA) last month released updated standards for measuring physician and hospital performance. For the first time, the organization recommended using standardized quality measures to ensure the comparability and accuracy of performance reporting.

In particular, the requirements call for the use of standardized measures that have been endorsed by the National Quality Forum (NQF) to measure physician performance. When NQF-endorsed measures are not available, the guidelines call for the use of standardized measures from other nationally recognized entities. NCQA also emphasized that there should be transparency on key methodological issues, including the assignment of patient results to physicians for measurement purposes, risk adjustment of quality data, and the statistical reliability of comparisons among physicians, practices, or medical groups.

The standards update the voluntary Physician and Hospital Quality (PHQ) certification program, which examines how health plans measure and report on the quality and cost of physicians and hospitals. NCQA launched PHQ in 2006 as a voluntary program to evaluate provider measurement program methods. So far, 64 health plans have received certification.

In an acknowledgement that health care purchasers, regulators, consumer groups, regional collaboratives, and information providers (such as Web sites) use such data to identify high performers, NCQA now enables these types of organizations to apply for PHQ certification.

New CMS Rules Would Pay for E-Visits; Require Hospice Providers to Improve Quality
The Centers for Medicare and Medicaid Services (CMS) recently proposed adding a new reimbursement code for electronic consultations, or "e-visits." The new code, to go into effect in 2009 after a period of comment, would reimburse providers for electronic visits with hospital patients after an initial, in-person consultation. The code is intended for use by providers who are consulted by a patient's attending physician but are not available for a face-to-face encounter.

If this rule is approved, it would be a major endorsement of electronic consultations and could pave the way for other insurers to follow suit.

Another recently approved CMS rule requires hospice providers to implement quality measurement and improvement programs. The rule comes at a time when a growing number of Americans are using hospice care. In 2007, Medicare spent about $10 billion on hospice care for Medicare beneficiaries, and costs are expected to increase at an annual rate of 9 percent through 2015, according to an AARP research report.

The new rule, which will take effect in December, mandates that hospices allow patients to help choose their treatment plans and demonstrate improvement in areas where they are found deficient. The performance data on hospices might eventually be available publicly; the federal agency already publishes data on the quality of nursing homes, hospitals, and home health agencies.

CMS Awards $24.5 Million to High-Performing Hospitals
In June, CMS announced that it had made $24.5 million in payments to recognize hospitals that excelled on 30 measures of clinical quality. These payments were made as part of a pay-for-performance demonstration program led by CMS and the Premier hospital consortium.

The three-year project involved 250 hospitals, which together serve 1.1 million patients. Premier officials said that, on average, the hospitals achieved a 15.8 percent increase in quality across the 30 measures. In addition, the variation in quality scores between the highest- and lowest-performing hospitals declined.

In a press release, acting CMS administrator Kerry Weems said, "Given these results, it is time to take the next step and implement hospital Value-Based Purchasing for the Medicare program, so that citizens across the nation can benefit from improved safety and quality [and] get the right care, every time."

2008 Health System Scorecard Finds Little Improvement
In the first health system scorecard it released two years ago, The Commonwealth Fund Commission on a High Performance Health System found that the U.S. fell far short of benchmarks for access, quality, efficiency, and other key measures of health system performance. The 2008 edition of the Scorecard paints an even bleaker picture, with the U.S. scoring an average of 65 out of a possible 100 across 37 indicators—slightly below the overall score in the 2006 report.

One of the primary reasons for the system's poor performance is the worsening access to care. In 2007, more than 75 million adults—42 percent of all adults ages 19 to 64—were either uninsured or underinsured, up from 35 percent in 2003. The Scorecard also found evidence that the billions of dollars spent on U.S. health care are often squandered on administrative costs, inefficient systems, wasteful care, or treatment of preventable conditions. The U.S. also failed to keep up with advances in health outcomes, falling from 15th to 19th among industrialized nations in terms of the number of premature deaths that could potentially have been prevented by timely access to care.

There have been some gains in quality of care, particularly in areas for which there have been national measurement and improvement efforts.

If the U.S. health system achieved benchmark levels of performance, there would be real benefits in terms of health, patient experiences, and savings, the report concludes. For example:
  • An additional 37 million adults would have an accessible primary care provider, and an additional 70 million adults would receive all recommended preventive care.
  • 100,000 fewer people would die from causes that could have been prevented by good care.
  • The Medicare program could potentially save at least $12 billion a year by reducing readmissions or reducing hospitalizations for preventable conditions.
  • If the U.S. were to lower the administrative costs of health insurance to the level found in Germany, which also has a blended public–private health system, the system could save $51 billion a year. Reaching administrative cost levels achieved in the best-performing countries would save an estimated $102 billion per year.

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