Project seeks framework for quality, public reporting
■ The new initiative also will pay for research on how best to gauge physician cost efficiency in treating 20 common conditions.
The Robert Wood Johnson Foundation is pouring $15.9 million into a new effort to give doctors and the public a more accurate assessment of physician performance.
The plan is to combine national Medicare and private health plan claims data and then use the data for public reporting of physician performance on quality and cost measures. Reporting in select areas is set for 2010.
The initiative comes on top of criticism that the nation's dozens of quality measurement and reporting efforts are redundant or rely on widely varying metrics. For example, a 2005 Institute of Medicine report on performance measurement called for a new office in Health and Human Services to coordinate and fund the development of metrics for pay-for-performance and public reporting programs.
Physician experts not involved with the recently announced project said it targets a major impediment to quality improvement: Doctors now get an incomplete, unreliable and confusing picture of their performance.
"The whole idea is that for physicians in practice to get a fair assessment of quality of care, we have to look at more than the six patients they have from Aetna," said Bruce Bagley, MD, medical director for quality improvement at the American Academy of Family Physicians. Dr. Bagley added that the project's goal of "pushing everybody to use the same measures is very important for national quality advancement."
The Robert Wood Johnson Foundation will spread the money for the initiative among three key groups.
The project will be coordinated by the Quality Alliance Steering Committee, of which the American Medical Association is a member. The panel -- in line for $8.7 million -- was formed in 2006 as a coalition of the AQA Alliance and the Hospital Quality Alliance, stakeholder collaboratives devoted to measuring the quality of ambulatory and hospital care. The committee is now based at the Engelberg Center for Health Care Reform, part of the Brookings Institution.
The America's Health Insurance Plans Foundation will get a $4.2 million grant to combine de-identified private-payer claims data and find a way to report the data consistently across plans because plans have different ways of tracking the same items. AHIP President and CEO Karen Ignagni called the new initiative a "transformational effort in health care."
"We are building a uniform approach to quality performance measurement and reporting, which is more easily said than done," she said. "There are roughly 60 different initiatives now going on around the country to aggregate data, all meritorious but doing it in very different ways."
Lastly, about $3 million will go to research in partnership with the AQA and the National Quality Forum on how to measure the cost of providing care for 20 common conditions. But developing accurate cost metrics poses a number of problems, said J. William Thomas, PhD, a professor of health policy and management at the University of Southern Maine who has studied the issue. "The reliability of cost-efficiency measures varies tremendously across clinical specialties," Dr. Thomas said via e-mail. (See correction)
Pilot programs planned
The project will not start from scratch, said Quality Alliance Steering Committee Co-Chair Mark B. McClellan, MD, PhD, former administrator of the Centers for Medicare & Medicaid Services. The new effort will use quality metrics endorsed by NQF, a congressionally recognized standards-setting body.
The AQA has adopted 144 NQF-endorsed measures in 22 areas of practice. The AQA helped organize a 2006 federally funded pilot project to measure physician quality in six communities around the country using public and private claims data.
Data collection for the new effort will start before the end of the year, organizers said, and criteria soon will be announced for communities to be recognized as "value exchanges," as determined by the U.S. Agency for Healthcare Research and Quality. Sites would be similar to those participating in the AQA-organized pilot project, and the data would be made available to participating communities to report at the clinic level, said Carolyn M. Clancy, MD, AHRQ director and co-chair of the Quality Alliance Steering Committee.
Doctors would not be obligated to participate, Dr. Clancy said, but chartered exchanges "are going to have to demonstrate they've got collaboration from a significant proportion, if not all, physicians in the area."
At some point, payers could decide to link payment to physicians' willingness to participate. Performance will be reported only at the clinic level, because sample sizes for individual physicians can be too small to yield accurate ratings.
The AMA-convened Physician Consortium for Performance Improvement has developed 206 quality measures, many of which were endorsed or used by NQF, AQA and the Medicare quality reporting initiative.
"The AMA remains deeply committed to health care quality improvement, and we support initiatives with strong physician input and leadership that help further that goal," said President-elect Nancy H. Nielsen, MD, PhD, a Buffalo, N.Y., internist. "The AMA continues to work to ensure that efforts to provide patients and physicians with useful information on both the quality and cost of care are presented in a way that is reliable and valid."