NQF draft reports: A light at the end of the tunnel?

Will measurement requirements finally decline?

There are hundreds of data measurements that hospitals and healthcare providers are required to submit to a variety of government and regulatory agencies. They are often repetitive exercises, but usually not enough so that what you do for one organization can be sent on to another one as well. The requirements take time, money, multiple systems, and cause a lot of frustration. But could the end be in sight?

Two new draft reports from the National Quality Forum (NQF) might lead to a consolidation of requirements and the creation of an "ideal data set" that would work for multiple organizations, preferably using a single reporting system.

The Measurement Applications Partnership, comprised of providers, payers, regulators, and others, released the two reports for public comment in August. Comment closed in mid-September, and interim reports are due for release by the beginning of October when more comment will be solicited.

The Clinician Performance Measurement Coordination Strategy (http://www.qualityforum.org/Setting_Priorities/Partnership/Clinician_Workgroup.aspx) is supposed to align measures and data sources, create an ideal measure set, define data platform principles, and determine a pathway for improving measure application. It also includes a draft version of the selection criteria used to assess measure sets.

The second draft report is the Coordination Strategy for Healthcare-Acquired Conditions and Readmissions across Public and Private Payers (http://www.qualityforum.org/Setting_Priorities/Partnership/Ad_Hoc_Safety_Workgroup.aspx).

The focus in the second report is on reducing nine hospital-acquired conditions: adverse drug events (ADE); catheter-associated urinary tract infections (CAUTI); central line-associated blood stream infections (CLABSI); injuries from falls and immobility; obstetrical adverse events; pressure ulcers; surgical-site infections; venous thromboembolism (VTE); and ventilator-associated pneumonia (VAP). It identifies three focus areas for aligning public and private efforts to reduce healthcare-acquired conditions and readmissions: measures, data, and coordination strategies.

The draft report calls for consistent measures that allow for valid comparisons and which are not onerous to providers. They should apply to patients regardless of payer and across all healthcare settings. The data should also be "clear, meaningful, and readily available," to consumers and payers alike, according to the draft.

Harmonizing reporting processes for government entities like AHRQ, CMS, and the CDC is mooted as a way to decrease the burden on providers, and safe care should be rewarded.

While both of these reports have the potential to make things easier for providers and those who manage quality data, some worry that the focus won't be on all the things that need attention. Felisha Bochantin, a senior coding analyst at Optum Insight in Ashley, IL, says that the things that worry her are the things that aren't reported. "If it isn't documented, it didn't happen," she says, and figuring out any ideal measure set still involves only the things that you actively measure. "What about near misses? You can talk all day long about data sources and data mining, but if it isn't reported, it didn't happen."

Still, defining quality measures is a big step, Bochantin says. And while what applies to one hospital might not apply to another, there are some truths that apply to all. Figuring out what they are is a capital-G good thing.

The length of time and the degree of difficulty in getting all of the different parties to sit down, agree to data sets, and potentially give up their own little fiefdoms of power will be considerable. The timelines on both of these reports stretch out almost a year before final editions are due to be released.

In the meantime, quality professionals should keep on top of the measures that are being promoted by major groups, and be involved with internal health IT initiatives so that you can ensure your systems can capture whatever data are necessary. "Quality professionals can't anticipate every possible data element that might be needed to satisfy the measurement demands of external groups. However, we can be involved in our organization's IT implementation plan," says Patrice L. Spath, MA, RHIT, a consultant in health care quality and resource management with Brown-Spath & Associates in Forest Grove, OR. "You need to get your input heard so your facilitywide information system is capable of gathering measurement data for today's requirements and sufficiently flexible to meet those in the future." When selecting IT systems, the potential for gathering reliable performance measurement data should be one of the considerations.

Another issue to consider moving forward is standardizing definitions between various providers, says Spath. "For instance, if a patient leaves the hospital and develops an infection, you have to be sure that what the physician in the office thinks is a hospital-acquired infection matches your definition. It may be classified as a nosocomial infection, even if they suspect it is."

The hope is that the work of NQF and its task groups will reduce duplication of data collection, Spath says. "But there is still a high likelihood that costs associated with performance measurement activities will continue to rise. That's why quality professionals must constantly seek more efficient ways of gathering data and analyzing results."

And just to show that the more things change the more they stay the same, within two weeks of the release of the draft reports that many hope will lead to less measure mayhem, the NQF endorsed 10 measures on end-stage renal failure and one on CT radiation.

For more information on this topic, contact:

  • Felisha Bochantin BS, CPC, CPC-H, CPC-I, Senior Coding Analyst, ICD 10 Content Development Team, Optum Insight. Ashley, IL. Telephone: (618) 485-2632. Email: felisha.bochantin@optum.com
  • Patrice L. Spath, MA, RHIT, Brown-Spath & Associates, Forest Grove, OR. Email: Patrice@brownspath.com.