Providers overwhelmed by requests for data may find their burdens eased as the result of an effort by three major accrediting organizations to create a common, industrywide set of performance measurement standards.
Called the Performance Measurement Coordinating Council, the group is an alliance of the American Medical Association's American Medical Accreditation Program, the Joint Commission on Accreditation of Healthcare Organizations and the National Committee for Quality Assurance. The council's goal is to ensure performance measurement processes are efficient, consistent and useful for consumers, purchasers, healthcare providers, the government and others who rely on them to make healthcare decisions.
"Working with three organizations like this with such substantial track records, I think the opportunity here is tremendous," says George Isham, M.D., chairman of the 15-member PMCC. "I was very heartened by the level of sincerity of the conversation at our first meeting."
The PMCC met for the first time in late September in Washington. "We identified some of the opportunities and had some very productive suggestions as to how we could move forward," Isham says.
He says the council will meet again early next year, after the three accrediting organizations' staff members research the possible collaborative efforts identified at the meeting. He declines to discuss those efforts publicly at this time.
After that, the group plans to meet three or four times a year, he says. Subgroups working on specific issues will meet more frequently if necessary.
Currently, AMAP, the JCAHO and the NCQA each set performance measurement standards in different sectors of the healthcare system. AMAP focuses on standards of quality for individual physicians. The JCAHO accredits a range of healthcare facilities, including hospitals and long-term and behavioral healthcare programs. The NCQA's accreditation process and performance measurement program -- Health Plan Employer Data and Information Set, or HEDIS -- focuses on care provided by managed-care organizations.
"Independently, our organizations are working aggressively to develop rigorous performance measurement programs for different levels of the healthcare system," said NCQA President Margaret O'Kane when the PMCC's formation was announced in May. "Working together, we can make performance measurement not only much less burdensome, but also more meaningful to consumers, employers and healthcare professionals."
A large part of the PMCC's first meeting in September focused on familiarizing the participating accrediting organizations with one another's processes for performance assessment, says Robert Mills, public information officer with AMAP.
"One of the goals for this particular meeting (was) for the members to come to know each other and have a chance to socialize and discuss informally whatever is of significance in their view," adds Al Buck, M.D., executive vice president for performance measurement and research at the JCAHO.
Buck also emphasized the council's support of Vice President Al Gore's new healthcare commission, the Forum, which was formed earlier this year. The advisory commission appointed by President Clinton was charged with promoting healthcare quality and protecting consumers by facilitating greater coordination in healthcare performance measurement efforts. Its goal is to help consumers choose plans based on quality rather than just cost.
Although some questioned whether the new collaborative effort was an attempt to pre-empt the Forum, the council feels its effort dovetails with the Gore undertaking.
"We absolutely want the work of this group to be supportive of and serve as a resource for the vice president's forum," Buck says.
Some industry organizations have been hesitant to comment on the PMCC because it is still in the early stages of development. Others, while cautious to note that the proof would be in the results the group achieves, say the PMCC's goal is welcome -- if not long overdue.
"We welcome the initiative of NCQA, JCAHO and AMAP to come together to coordinate the myriad redundant and inconsistent reporting expectations faced by physicians and their organizations," says Nancy Oswald, president of the National Independent Practice Coalition. "We encourage collaboration on standards so that we can compete on quality."
Says Julie Sanderson-Austin, a registered nurse and vice president of quality management and research for the American Medical Group Association: "Absolutely as an organization we favor standardization in quality measures."
On the HMO side, Joel Hyatt, M.D., assistant medical director for Kaiser Permanente in Southern California, says: "We're very supportive at this point. The world of quality measurement and requests for more and more data have become more confusing and less standardized. Hopefully, the PMCC, which is bringing together some of the biggest players in quality reporting, can come to some agreement and lead to greater consistency and standardization around measurement and reporting."
Many measures can be inconsistent and vary across the country, depending on which group issues the guidelines. Kaiser's Hyatt points to prostate cancer screening with PSA tests, which result in a number of false positives. "Should a PSA screening rate be high, low or in the middle?" he asks. "How you interpret that is not linked to any consensus of what is appropriate."
Another example Hyatt gives is related to Caesarean sections. "There is a lot of discussion about lowering and lowering rates, but no one really knows what the right C-section rate is," he says. "Is a 5% rate right? A 20% rate wrong? Ultimately, the correct rate has to be linked to outcomes.
"Hopefully, the PMCC can bring some logic around these issues and drive purchasers and regulators, and even consultants who are requesting data from health plans, to use a more standardized approach."
Another common criticism of performance measurement is that costs for data collection and reporting can be high. The PMCC hopes to help address these concerns by:
The council also plans to address other issues, such as standardization of techniques to adjust risk for health differences among covered patients.
At this point the whole process is still conceptual, notes the AMGA's Sanderson-Austin. "What our group will be concerned about is what comes out of the meetings, what measures they'll choose to collaborate on," she says.
Kaiser's Hyatt says the efforts are needed.
"The PMCC has a real opportunity here," he says. "We're hoping that they can rise to the occasion. Otherwise, health plans and other organizations are facing a barrage of requests with real inconsistencies and other inappropriate measurement requests without a clear understanding of what the intended outcome should be for a particular measure."
Sandy Moretz is an Atlanta-based freelance writer who focuses on healthcare.