NQF Delivers Recommendations to HHS on Performance Measures for Use in Medicare Quality Programs

Last week, the National Quality Forum (NQF) delivered recommendations to the U.S. Department of Health and Human Services (HHS) on quality measures being considered for use in 17 Medicare quality programs affecting more than 64 million Americans. The measures are used to track and report on the performance of health-care entities or for making reimbursement decisions in performance-based payment programs. NQF convened stakeholders from across the health-care ecosystem to review 52 unique measures and 81 measure-program combinations and provide consensus-based recommendations on which ones support public health objectives and are appropriate for use in Medicare quality programs. The review is conducted by the Measure Applications Partnership (MAP), a public-private partnership funded by the Centers for Medicare & Medicaid Services (CMS) and convened by NQF since 2011.

MAP makes recommendations based on criteria such as how well measures address program goals, workload required to gather and analyze the necessary data, and scientific acceptability. Among key areas of focus for MAP are measures that advance health equity, encourage alignment across programs, promote patient safety, consider social determinants of health, and include risk adjustment. Of the measures and measure-program combinations reviewed, MAP expressed support for 10, conditional support for 60, declined to support two, and declined to support seven with potential for mitigation. MAP did not vote on one measure for use in two programs as CMS does not intend to implement the measure for those two programs. A detailed spreadsheet of the recommendations is available to download. 

“Performance measures used in federal healthcare programs affect high-stakes decisions about care and payments that are aimed at improving the quality of healthcare for millions of Americans,” said Dana Gelb Safran, ScD, president & CEO of NQF. “It is critically important that these measures be based on the latest measurement science and informed by a diverse range of perspectives from patients, clinicians, payers, and many other healthcare stakeholders.”

The MAP involves approximately 150 health-care stakeholders representing nearly 90 private-sector organizations, as well as liaisons from six federal agencies. MAP serves a vital role enabling public engagement and transparency in important federal programs. This year’s review garnered a particularly high level of engagement as the number of public comments received increased dramatically. More than 900 comments were submitted for this cycle, surpassing the previous one by more than 300.

Federal programs using MAP-reviewed measures include: Ambulatory Surgical Center Quality Reporting Program; End-Stage Renal Disease Quality Incentive Program; Home Health Quality Reporting Program; Hospital Inpatient Quality Reporting Program; Hospital Outpatient Quality Reporting Program; Hospital Value-Based Purchasing Program; Inpatient Psychiatric Facility Quality Reporting Program; Inpatient Rehabilitation Facility Quality Reporting Program; Long-Term Care Hospital Quality Reporting Program; Medicare Promoting Interoperability Program; Medicare Part C & D Star Ratings; Merit-based Incentive Payment System; Prospective Payment System-Exempt Cancer Hospital Quality Reporting Program; Rural Emergency Hospital Quality Reporting Program; Skilled Nursing Facility Quality Reporting Program; and Skilled Nursing Facility Value-Based Purchasing Program.