AMAP, JCAHO, and NCQA will coordinate measures
The country's dominant health care accrediting organizations - the American Medical Accreditation ProgramSM (AMAP), the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), and the National Committee for Quality Assurance (NCQA) - will collaborate to design performance measurements, according to an agreement announced in late May.
The agreement establishes the Performance Measurement Coordinating Council (PMCC), a 15-member group that will coordinate the effort. The PMCC will begin work at its first meeting this summer and will meet three to four times per year. Work groups addressing specific issues will meet in person and via conference call more frequently.
"Independently, our organizations are working aggressively to develop rigorous performance measurement programs for different levels of the health care system," says NCQA president Margaret E. O'Kane. "Working together, we can make performance measurement not only much less burdensome, but also more meaningful to consumers, employers, and health care professionals."
Increased participation sought
One aim to is to increase participation in the voluntary programs, says Randolph D. Smoak Jr., MD, chair of the AMAP governing body and vice chair of the American Medical Association's board of trustees. "More efficient measurement will lead to broader participation in accreditation programs, which will lead to quality improvement, which will lead to better care and service. Ultimately, patients and the public are the real winners," he says.
Formation of the PMCC dovetails with the recent recommendation from President Clinton's Advisory Commission on Consumer Protection and Quality in the Health Care Industry urging greater coordination in health care performance measurement efforts. The PMCC expects to work through the Forum for Health Care Quality Measurement and Reporting, a group being formed by Vice President Al Gore that will seek to incorporate existing private sector efforts.
The PMCC has developed a consensus statement, "Principles for Performance Measure ment in Health Care," that outlines the following areas of purpose: the rationale behind performance measurement efforts; appropriate uses of performance data; specific areas on which measures should focus; guidelines for using performance data for comparative purposes; general requirements for cost-effective measurement; and specific opportunities for collaboration.
Performance measures currently vary from one level of the health care system to the next, but there is overlap. For example, member satisfaction, immunization rates, and cervical cancer screening rates have been used to assess providers, facilities, and plans alike. Other broadly applied performance measures include cesarean rates, mammography screening rates, measures of the accessibility of care, cost measures, utilization rates (e.g., coronary artery bypass graft surgeries per 1,000 members), and average office wait times.
One goal: Reduce costs
A common criticism of performance measurement activities - even from those who appreciate their importance to quality improvement - is that costs for data collection and reporting can be high. The PMCC's efforts will help to reduce those costs by:
· coordinating identification and/or development of groups of universal measures (i.e., measures that could be used to assess performance of physicians, facilities, or health plans in the same ways);
· standardizing data requirements for different measurement systems;
· devising means of coordinating measurement activities among physicians;
· organizing providers, facilities, and health plans;
· establishing more efficient verification and data quality assurance systems;
· developing guidelines for the appropriate use of performance data.
The PMCC also will tackle issues such as standardization of risk adjustment, which is a key issue for measuring performance at the physician, facility, and health plan levels. Ultimately, the group hopes to articulate principles to deal with risk adjustment that will help the science of performance measurement move forward.
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