Group aims for consistency in quality measurement

Who defines medical quality? Three accrediting bodies have answered that question with the formation of the Performance Measurement Coordinating Council, which will bring greater uniformity to national assessment efforts. The goal: a reduced burden on physicians for data collection and more meaningful information for consumers and health care purchasers.

The 15-member council, which is scheduled to hold its first meeting in September, will set priorities for performance measurement and standardize definitions for common indicators used by the three groups. The council will represent the major players in accreditation-based assessment: the National Committee for Quality Assurance (NCQA), which accredits health plans; the Joint Commission on Accreditation of Healthcare Organizations, which accredits hospitals, health systems, and other health care entities; and the American Medical Accreditation Program (AMAP) of the American Medical Association (AMA), a new project to accredit physicians.

"Together, we form a private sector quality measurement umbrella," says William Jessee, MD, the AMA's vice president for quality and managed care.

With the collaboration, physicians won't have to provide slightly different data for the same performance measure, such as treatment for otitis media or cesarean rates. Whether they are submitting data for individual accreditation or to health plans, the definitions would be the same.

Avoiding data collection nightmares

In an initial position statement, the three groups said the council will seek to identify measures that can be used for multiple purposes - for example, to assess both providers and health plans. The council will delve into issues of risk adjustment and data quality as well as guiding principles of quality measurement.

"There's a great need for good, consistent, standardized quality information," says NCQA spokesman Barry Scholl. "There's a duplication of effort that doesn't serve anybody in the long run. It increases the burden on providers but doesn't service consumers and purchasers."

While different organizations may agree on broad performance indicators such as measuring cesarean rates, different definitions of who to count and who to exclude can make data collection difficult and comparisons impossible.

"We felt we had an obligation to coordinate efforts and maximize the value we all produce," says Jessee. "If we don't do that, we're going to end up creating more problems than solutions."

In some cases, an accrediting body, such as AMAP, may create a measure that is only appropriate for physicians. But that is likely to be the exception.

"Our expectation is that many of the measures are going to be relevant at the level of the physician, the hospital, ambulatory surgery center, the network, and the health plan," says Jessee. "If it's relevant at all those levels, we expect this council to make sure we all agree on what the measure is. We all line up on the same set of measures."

Must standardize reporting, too

John E. Ware Jr., PhD, executive director of the Health Assessment Lab at the New England Medical Center in Boston and a leader in the measurement field, says he applauds the move toward standard definitions of indicators and common goals for measurement but that the council should broaden its scope as well as its membership base.

"Standardization doesn't end with the [performance assessment] database," he says. "We also have to standardize the display and interpretation of results."

Ware notes that when the NCQA created a standard health plan member survey, some health plans condensed the responses for good, very good, and excellent and reported their results in a more favorable light.

Ware, a member of the Joint Commission's Council for Performance Measurement, also urges the three groups to include other major players in the quality field, such as the Foundation for Accountability in Portland, OR, which develops measurement sets, and the Medical Outcomes Trust in Boston, which sets standards for patient surveys.

"This is a big step in the right direction," he says. "I hope it represents a beginning that will lead to an even broader representation of points of view and indicators."

Meanwhile, creation of the council coincides with a concern of President Clinton's Advisory Commission on Consumer Protection and Quality in the Health Care Industry for greater coordination of performance measurement efforts. As a result, the president directed Vice President Al Gore to establish a Forum for Health Care Quality Measurement and Reporting.

It isn't clear how the forum will evolve and what role, if any, the Performance Measurement Coordinating Council may play in its development. "We expect this coordinating council will work quite closely with the vice president's forum," Scholl says.