Three leading healthcare accrediting agencies-one for hospitals, one for health plans and one for doctors-have joined forces to establish some standards in the burgeoning field of performance measurement.
As things stand, accrediting groups and internal quality management teams can define performance every which way, even for such apparently simple issues as coronary artery bypass graft mortality. There are enough different ways of measuring CABG mortality that results aren't necessarily comparable from hospital to hospital or surgeon to surgeon.
And it is extremely expensive for providers to measure and remeasure results in accordance with whatever format the outside agency requires.
The three big accrediting agencies want to eliminate the confusion. The Joint Commission on Accreditation of Healthcare Organizations, the National Committee for Quality Assurance and the American Medical Accreditation Program last week said they are creating a joint "performance measurement coordinating council."
The council's mandate is to figure out the best way of measuring healthcare providers' performance. It then will spell out standards that performance measurement efforts should meet.
Sen. Bill Frist (R-Tenn.), a transplant surgeon with a keen interest in improving healthcare quality, applauded the private-sector initiative. "With the growing interest in quality, people want to know exactly who does what in accreditation and quality improvement," he said. "The new council is an excellent response to these questions."
The Joint Commission is well-known as the leading accreditor of hospitals, nursing homes, laboratories and other facilities. The NCQA accredits health plans and evaluates their quality of care through its HEDIS yardstick. AMAP is a new initiative from the American Medical Association to accredit physician practices.
The council will consist of 15 people, five appointed by each organization. The Joint Commission, for example, will appoint people from its Advisory Council on Performance Measurement. These are experts in the subject, not members of the board of commissioners or representatives of interest groups like the American Hospital Association.
The NCQA already has appointed two of its five. They are Helen Darling, formerly a major purchaser with Xerox Corp. and now with Watson Wyatt, and David Eddy, M.D., an independent consultant in performance measurement.
The council is supposed to develop consistent measures that work across sector boundaries, whether physicians or hospitals or health plans. It also will try to come up with consistent, suitable risk-adjustment methodologies.
Dennis O'Leary, M.D., president of the Joint Commission, said it's critical for accreditors to develop "top-to-bottom expertise and input" as healthcare delivery organizations become more interrelated. As it gets harder and harder to separate the hospital from the health plan from the doctor, consistent means are needed to measure their output, he said.
"I think O'Leary is correct," added Myra Snyder, executive director of the Center for Health Care Quality Improvement in San Francisco. "Anything that can standardize throughout the healthcare delivery system is definitely to everybody's benefit."
Ideally, she said, such standards should be useful to patients. "If we get the patient more and more empowered with what the standard is, they'll make sure it happens." But she isn't sure that's where this project is headed: "It sounds like for NCQA, the Joint Commission and AMAP, the focus is on the provider of care."
But Cary Sennett, M.D., executive vice president of the NCQA, took issue with that view. "I think ultimately it's the patient we're trying to serve here. Redundancy and waste of resources serve no one. Resources that are used inefficiently for measurement aren't used for patient care."
The idea behind this initiative is to help all healthcare providers focus on the same things and show where the priorities are. "In directing everyone's attention to the same issues, we think . . . there will be some real synergy here. The patient will be served because the system responds more," Sennett said.
Alan Zwerner, M.D., chief medical officer of HealthNet, a large HMO based in Woodland Hills, Calif., applauded the new council as an effort to create a level playing field. "It also locks people in. They can be measured by whomever they choose but not change indicators midstream," he said.
Performance measurement is assuming a larger and larger role in accreditation, as accreditors move away from traditional standards and processes-based evaluations.
Of course, this standardization effort bears the potential to diminish the importance of some proprietary performance measurement systems. Those that don't meet the council's high standards might find themselves high and dry, without customers.
"That's how markets work," Zwerner said. "If there are many products and some clearly excel, they have the potential to become Microsoft. But it's a big industry, and I'm sure there's plenty of room for lots of players to excel."