Now that long-awaited quality standards for outpatient care have been completed, the next step will be to put them to use in clinical practice and in evaluating and rewarding physicians. There are signs it may happen soon, though how widespread their use will be remains a question mark.
The National Quality Forum board of directors last week approved the set of 36 voluntary consensus standards for ambulatory care. Each standard was evaluated on its importance, scientific soundness, feasibility and usability.
As the U.S. health system moves ahead with pay-for-performance and other quality-improvement programs, a myriad of practice guidelines and measures has been developed offering slightly different versions of the same concepts. Aimed at gauging the performance of physicians in outpatient settings, the NQF measures include standards for the treatment of asthma, behavioral health, heart disease, hypertension and osteoarthritis, as well as prenatal care and prevention, immunization and screening services.
CMS spokesman Peter Ashkenaz said his agency is going to make extensive use of the NQF measure set. "It's going to serve as the standard as we pull together (physician) pay-for-performance," he said. The CMS on April 1 began a national pay-for-quality demonstration project involving 10 large medical groups whose combined total of more than 5,000 doctors treat approximately 200,000 Medicare recipients. The project will provide bonuses of up to 5% of an annual performance target.
Reva Winkler, co-director of NQF's ambulatory-care project, said NQF received funding from the CMS to quickly develop standards derived from existing measures forged by the CMS' Doctor's Office Quality project, the American Medical Association-led Physician Consortium for Performance Improvement and the National Committee for Quality Assurance.
"All 36 standards were derived from those three sources," Winkler said. "There was a great deal of interest in getting a set of measures out there."
Buffalo, N.Y.-based internist Nancy Nielsen, who serves as speaker of the AMA's House of Delegates, said there are three major plans in her area and all ask physicians for something different. These include process and outcome measures, and "so-called efficiency measures," she said. "The good guys to them are the ones who spend the least amount of money."
Nielsen added that she thought this process was being driven by the CMS' move toward pay-for-performance and by employers who are pushing for more data from health plans -- who, in turn, are pushing physicians to provide them with that information.
America's Health Insurance Plans spokesman Larry Akey agreed that some payers will be using the measure set, but how and to what extent is a major question.