NQF endorses standards for non-physician clinicians

Move expected to impact care in outpatient centers

The National Quality Forum (NQF) has endorsed 67 clinician-level consensus standards related to cancer care, infectious diseases, perioperative care, and care provided by thousands of medical professionals who are not MDs.

"This is a specific set of measures for practitioners that can bill Medicare," says Helen Burstin, MD, MPH, senior vice president for performance measures, noting that covered clinicians include, among others, physical therapists, occupational therapists, podiatrists, clinical psychologists, and social workers.

This large group of non-physician clinicians hasn't "been brought in [to the standards process] before," Burstin adds.

NQF also endorsed four facility-level measures in surgery and anesthesia, 17 measures addressing prevention and management of stroke across the continuum of care, and three measures for influenza and pneumococcal immunizations — for a total of 91 consensus standards.

Experts say standards needed

Clinical experts engaged by NQF to serve on steering committees to develop the standards emphasized the need for these measures in prepared statements. "There's an overwhelming amount of misinformation about what constitutes good care," says Suzanne Miller, MD, director of behavioral medicine at the Fox Chase Cancer Center in Pennsylvania and co-chair of the steering committee on clinician-level cancer care. "Quality measures, particularly at a clinician level, pave the path for communicating with patients and providing patient-centered care in a comprehensive way."

For the first time, NQF standards are addressing HIV/AIDS and hepatitis. "Given the known gaps and variations in care for patients infected with HIV/AIDS and hepatitis B and C, it is imperative that the medical community begin to systematically measure itself at the individual clinician and system level to identify where improvement efforts are needed," says Fred Rachman, MD, CEO and chief medical officer at the Alliance of Chicago Community Health Services, who co-chaired NQF's steering committee on clinician-level infectious diseases.

"The NQF process is instrumental for endorsing a single set of consensus standards that will help alleviate the multiple, competing sets of measures for HIV/AIDS and hepatitis against which clinicians are currently measured. This supports our ultimate aim — a uniform standard of care that every consumer can expect."

According to NQF, these new standards "will fill gaps in assessing clinician performance." Says Burstin: "They are specifically being done as part of [The Centers for Medicare & Medicaid Services'] effort to have measures available for these practitioners. [If they fail to meet them] they cannot participate in the PQRI [Physician Quality Reporting Initiative] program." Under the program, clinicians can earn bonus payments — or be penalized — based on how their performance is rated.

Burstin adds that for quality managers, the standards "offer additional quality measures — particularly for those who practice in outpatient and related clinics. So, for example, they would speak to the quality of care provided by physical therapists associated with the hospital in outpatient clinics."

To read the full specifications for all of the new NQF-endorsed voluntary consensus standards, as well as NQF's research recommendations, go to: www.qualityforum.org.

[For more information, contact:

Helen Burstin, MD, MPH, Senior Vice President for Performance Measures, National Quality Forum, 601 13th Street NW, Suite 500 North, Washington, DC 20005. Phone: (202) 783-1300.]