GAO asks HHS for universally aligned quality measures

The Government Accountability Office (GAO) sent a report on October 13 to the Department of Health and Human Services (HHS) urging for better alignment of healthcare quality measures. The conclusion of the 42-page document is that payers haven’t agreed on what quality measures to track, which puts a burden on healthcare organizations.

“For example, a physician may participate in Medicare and a private health plan that each use different measures for assessing the care of diabetic patients,” the GAO wrote. “In another example, a physician may report similar measures to multiple payers that assess blood sugar levels among diabetic patients, but each measure may use a different threshold to determine which patients have their blood sugar levels under control.”

The GAO says there are three main drivers of these misalignments:

1.    Dispersed decision-making: Each public and private payer decides which quality measures they want to use and which specifications apply. This is done without regard to the measures that other payers are using.
2.    Variation in data collection and reporting systems: The electronic health record (EHR) systems, paper records, or clinical data registries that physicians use all differ in how they collect and report quality data. Without standard measures, there’s little incentive for EHR vendors to create systems to facilitate data collection and reporting.
3.    Few meaningful measures: Of the hundreds of quality measures currently used, only a few are seen as leading to meaningful quality improvements.

"What we have right now is a labyrinth of confusing metrics, specifications, and reporting rules that serve no one," said Kathleen Ciccone, RN, introducing a Healthcare Association of New York State report calling for streamlined measures.

The GAO report recommends that HHS, CMS, and the Office of the National Coordinator for Health Information Technology develop a comprehensive plan, including timelines, for more meaningful quality measures and electronic quality measures. The GAO particularly wants to see the creation of standardized data elements to report on core electronic quality measures.

The issue of excessive quality measures was brought up by Peter Pronovost, MD, director of the Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, in a May opinion piece published in The Journal of the American Medical Association. He argued that despite the increase in different quality measures, there are no standards for determining the accuracy and timeliness of quality data.

“What is striking is that there has been an increase in the number of measures that are publicly reported and [in] the amount of money at risk for performance on those, but no standards on how accurate or inaccurate a measure needs to be before you are paid,” Pronovost told HealthLeaders Media.

He pointed to the use of readmission rates as a quality measure, even though not all readmission cases are preventable. Meanwhile, only one out of the six most common causes of patient safety problems, hospital-acquired infections, has a nationally validated approach for measuring quality.

 “CMS should task an agency with defining standards of what makes good measures and setting accuracy requirements before implementing measures in pay-for-performance and public reporting,” he wrote in the opinion piece. “Such an agency would serve a similar role for healthcare as the Federal Accounting Standards Advisory Board does for financial reporting. Under this system, professionals set accounting standards, performance is audited and transparently reported, and journalists report on validated measures, working from a common source of standards.”

Pronovost followed up by suggesting that the National Quality Forum is the natural agency to play such a role in healthcare, though he said another agency or organization could also fill the void.