Look­ing at value

NQF backs ef­fort fo­cus­ing on re­source use, costs

Modern Healthcare - - THE WEEK IN HEALTHCARE - An­dis Robeznieks

While health­care’s finest minds con­tinue to wres­tle over how to mea­sure qual­ity, the Na­tional Qual­ity Forum lit a match near an­other po­ten­tial pow­der keg by tak­ing the first steps to­ward defin­ing how to mea­sure “value.”

Last week, the NQF re­leased a set of four en­dorsed “re­source use” mea­sures that in­cluded two de­vel­oped by the Na­tional Com­mit­tee for Qual­ity As­sur­ance and two from Bloom­ing­ton, Minn.-based HMO Healthpart­ners that ad­dress the costs of di­a­betes and car­dio­vas­cu­lar care along with to­tal pri­mary-care costs and pri­mary-care to­tal use of re­sources. Sim­i­lar mea­sures be­ing con­sid­ered in­volve asthma, chronic ob­struc­tive pul­monary dis­ease, hip and knee re­place­ment and pneu­mo­nia.

“I find the NQF ac­tion fas­ci­nat­ing,” Dr. Robert Wachter, Univer­sity of Cal­i­for­nia San Fran­cisco pro­fes­sor and Depart­ment of Medicine chief, said in an e-mail. “Over the past decade, na­tional or­ga­ni­za­tions like NQF and health­care de­liv­ery or­ga­ni­za­tions such as hos­pi­tals have in­vested heav­ily in try­ing to im­prove safety, qual­ity, ac­cess and pa­tient sat­is­fac­tion. Now that ev­ery­one is con­sumed with the im­per­a­tive to bend the cost curve, it is still an open ques­tion whether these ef­forts will be on their own axis or will be some­how blended into ex­ist­ing ef­forts. When the lat­ter course is cho­sen, the re­sult­ing ac­tion is some­times placed un­der the head­ing of ‘value.’”

Wachter added that there is a risk that some will be con­fused and will think an NQF mea­sure is about qual­ity when it’s ac­tu­ally about cost sav­ings.

Dr. He­len Burstin, NQF se­nior vice pres­i­dent for per­for­mance mea­sures, said she is un­aware of any con­fu­sion so far. Burstin re­ferred to the mea­sures as “build­ing blocks” to­ward defin­ing value while also adding more trans­parency, and she added that the new mea­sures should not be viewed in iso­la­tion but rather in tan­dem with qual­ity mea­sures.

“Cost and qual­ity need to be re­ported to­gether,” Burstin said. This point was echoed by Su­san Pisano, spokes­woman for the Amer­ica’s Health In­sur­ance Plans trade as­so­ci­a­tion, who said her group sup­ported the new mea­sures.

Those who op­pose the mea­sures have un­til Feb. 29 to file an ap­peal ask­ing NQF to re­con- sider its en­dorse­ment, but Burstin said NQF “did not get a great deal of push­back on the con­cept” of re­source-use mea­sures. Dr. Dan Blue, pres­i­dent of San­ford Clinic, Sioux Falls, S.D., said they shouldn’t.

“We shouldn’t fear this, we shouldn’t re­sist it,” Blue said. “It’s a mir­ror, and it’s a re­flec­tion of what we do.”

Blue said the new mea­sures will pro­vide data needed for con­tin­u­ous im­prove­ment, and Dr. Rhonda Ket­ter­ling, chief med­i­cal of­fi­cer of San­ford Health Fargo in North Dakota, called the mea­sures “good prepara­tory data” in the move to­ward ac­count­able care or­ga­ni­za­tions and other health­care re­form-re­lated busi­ness mod­els. While smaller, in­de­pen­dent prac­tices may not ap­pre­ci­ate the mea­sures so much, she said, they will help show the value of care pro­vided by in­te­grated sys­tems such as San­ford.

Dr. Bruce Ba­gley, the Amer­i­can Academy of Fam­ily Physi­cians’ med­i­cal di­rec­tor for qual­ity im­prove­ment for and a mem­ber of the NQF Con­sen­sus Stan­dard Ap­proval Com­mit­tee, said for some small prac­tices or for in­di­vid­ual physi­cians with a few di­a­betic or car­diac pa­tients the mea­sures may not be sta­tis­ti­cally vi­able. But, if a pri­mary-care doc­tor al­ways pre­scribes brand-name drugs or al­ways or­ders more tests or con­sul­ta­tions, Ba­gley said “that will show up” with the new mea­sures for to­tal costs and re­source use.

Dr. Lyle Swen­son, pres­i­dent of the Min­nesota Med­i­cal As­so­ci­a­tion and an in­ter­ven­tional car­di­ol­ogy spe­cial­ist with East Metro Car­di­ol­ogy in St. Paul, said his or­ga­ni­za­tion is “all in fa­vor” of mea­sures that al­low more trans­parency, help ed­u­cate the public on the true costs of health­care, and pro­vide “stan­dard­iza­tion in­stead of a chaotic Wild West” sit­u­a­tion where dif­fer­ent or­ga­ni­za­tions are all ask­ing for some­thing dif­fer­ent from physi­cians.

On the other hand, he is con­cerned about re­duc­ing ev­ery­thing to a num­ber as medicine adopts more big busi­ness prac­tices.

“Our main fo­cus is the pa­tient in front of us, but big or­ga­ni­za­tions look at large pop­u­la­tions over time and ask, ‘How did we do last year? How did we do last month?’” Swen­son said. “But we don’t just pro­vide a ser­vice. There’s judg­ment in­volved, there’s the pa­tient-physi­cian re­la­tion­ship, em­pa­thy and tak­ing care of peo­ple in dif­fi­cult times.”

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