A coalition founded by the two largest medical specialty societies, a trade association for the health insurance industry and a federally funded healthcare quality improvement organization have agreed on supporting a set of 26 performance measures for physicians in ambulatory-care settings.
The coalition, called the Ambulatory care Quality Alliance, or AQA, was organized in 2004 by the American Academy of Family Physicians, the American College of Physicians, America's Health Insurance Plans and the Agency for Healthcare Research and Quality with the aim of finding common ground on physician-level performance metrics to improve quality of care and lay a foundation for pay-for-performance programs.
Theirs is the second batch of ambulatory-care measures made public in the past two weeks. On April 21, the National Quality Forum released for public comment a draft set of 50 performance measures for ambulatory care.
"Most of the 26 AQA performance measures are in the NQF draft measures and come from the American Medical Association's evidence-based Physician Performance Measurement Set, said Douglas Henley, M.D., executive vice president of the 94,000-member American Academy of Family Physicians.
Henley said the alliance was not attempting to pre-empt the NQF or create a rival list, but to pick a smaller set of metrics that physicians and payers could agree on now. Final approval of the NQF's set by its board of directors is not expected until mid-summer or early fall.
"We're very supportive -- not only the academy, but all the other principals of the AQA -- of the NQF process," Henley said. "We felt that it was important in the spring of 2005 to identify this starter set, because many payers and Congress are looking to 2006 to implement some performance measures.
"We're talking about a sea change of how the whole healthcare system behaves, including how physicians and other providers get their work done and get paid," he said.
Coming up with a basic list now enables payers to incorporate the measures into pay-for-performance arrangements that will be used by payers and self-insured employers next year, Henley said. As the NQF list is balloted and approved, the AQA will take a look at the remainder of the NQF measures with an eye toward endorsement by the alliance for possible use in 2007.
"We will continue to discuss the next step beyond this," Henley said.
Carolyn Clancy, M.D., director of the Agency for Healthcare Research and Quality, also said the intent of the AQA effort is to "prioritize an implementation strategy" and not compete with the NQF in selecting or approving specific measures.
She, too, stressed a sense of urgency, driven by payers and consumers.
"It was very important to signal now the progress that has been made," Clancy said, but a subsequent expansion of the AQA list will rely on NQF-approved measures.
"Our goal here is harmonization, period," she said.
Many of the alliance guidelines are standard fare for quality improvement programs: the prescription of beta blockers after hospitalization for acute myocardial infarction, the percentage of patients ages 50 to 64 who were given flu shots and the timely screening of adults for colorectal cancer.
Two of the guidelines are for "efficiency," a word physicians often interpret as purely for cost control, but Henley said the two selected -- both of which are designed to gauge the appropriate use of antibiotics in treating children -- also have evidence to support their positive impacts on patient outcomes.