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NATIONAL CONSENSUS STANDARDS FOR PHYSICIAN PERFORMANCE: ROUND 1

NATIONAL CONSENSUS STANDARDS FOR PHYSICIAN PERFORMANCE: ROUND 1. Kenneth W. Kizer, M.D., M.P.H. President and CEO National Quality Forum August 22, 2005. Presentation Overview. Provide some context for physician performance standards

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NATIONAL CONSENSUS STANDARDS FOR PHYSICIAN PERFORMANCE: ROUND 1

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  1. NATIONAL CONSENSUS STANDARDS FOR PHYSICIAN PERFORMANCE: ROUND 1 Kenneth W. Kizer, M.D., M.P.H. President and CEO National Quality Forum August 22, 2005

  2. Presentation Overview • Provide some context for physician performance standards • Provide an overview of the NQF Ambulatory Care PM Project: What has occurred to date? What is forthcoming?

  3. THE IDEA OF HAVING STANDARDS FOR PHYSICIAN PERFORMANCE IS NOT NEW

  4. The Quest for Healthcare Quality “If a physician make a large incision with the operating knife and cure it,…, he shall receive ten shekels in money. If a physician make a large incision with the operating knife, and kill him,…, his hands shall be cut off.” Code of Hammurabi, 1870 BC

  5. TODAY’S INCREASED ATTENTION TO HEALTHCARE QUALITY IS BEING DRIVEN BY AN UNPRECEDENTED CONFLUENCE OF FORCES

  6. Healthcare Quality Improvement Driving Forces • Knowledge of deficiencies • Rising healthcare expenditures • Purchaser activism • Consumerism • Regulation and accreditation

  7. A CROWDED FIELD Who are the “players” in the performance measurement and quality improvement game?

  8. A partial list of the Alphabet Soup of PM/QI-Related Organizations JCAHO NCQA CMS IOM AHRQ FDA NQF CDC QIOs HQA GAO PCPI OPM NBCH ACQA Leapfrog MedPAC ACMQ IHI WBGH PBGH QUIC UHC ABMS

  9. Lots of Signals….. BUT Little Direction

  10. There is need for a single national entity to be the steward for healthcare performance measurement and quality improvement.

  11. The NATIONAL QUALITY FORUM (NQF)

  12. NQF-ENDORSED CONSENSUS STANDARDS

  13. NQF Consensus Development Process Board of Directors, NQF Staff & Management Member Councils, Non-member External Entities Conceptualize and Plan Project Appoint Steering Committee and Technical Advisory Panels NQF ( nominations from membership and public) Steering Committee with NQF Staff (any entity can propose measures, etc., for consideration Identify (open call) and Evaluate measures, etc.; Propose candidate voluntary consensus standard (VCS) Review and Revise Member Councils, Member Organizations, Public Vote by Member Councils Member Organizations Member Councils, Member Organizations, Public Approved by All Member Councils Review and Revision of unapproved VCS Review and Revision of unapproved VCS Repeat Vote Approved by at least 2 Councils Approved by 0 or 1 Council (no further action) Board of Directors Vote Board of Directors Appeals of Board-endorsed VCS Members and Nonmembers directly and materially affected by VCS NQF-Endorsed Voluntary Consensus Standard

  14. NQF National Consensus Standards:Patient Safety • Patient Safety Strategic Priorities (2001) • Serious Reportable Adverse Events (2002) • Safe Practices (2003) • Standardized Patient Safety Taxonomy (2005) • Improved Medication Use Recommendations (2005) • Improved Informed Consent Process (2005)

  15. NQF National Consensus Standards: Institutions/Settings of Care • Acute Care Hospital National Performance Measures • Initial Set (2003) • Nursing Care PMs (2004) • Cardiac Surgery PMs (2004) • Coordination of Care PMs (2005) • Mortality for AMI, CHF and CAP (2005) • HCAPHS (2005)

  16. NQF National Consensus Standards: Institutions/Settings of Care • Nursing Home Care Performance Measures (2002, 2004) • Home Care PMs (2005) • Palliative and Hospice Care Framework (2005) • Ambulatory Care (2004-2008) • Dialysis Centers/ESRD (2006)

  17. NQF National Consensus Standards: Conditions/Populations • Diabetes (2002, 2005) • Cancer Care Quality Measures (2004-2007) • Deep Venous Thrombosis (2005-2007) • Child Healthcare PMs (?2006) • Behavioral Healthcare PMs (2005-2006)

  18. NQF National Consensus Projects • National Priorities for Healthcare Quality Measurement and Reporting • 15 Healthcare conditions priorities • 5 Process of care priorities • 2 Infrastructure priorities

  19. NATIONAL CONSENSUS STANDARDS FOR AMBULATORY CARE

  20. NQF National Consensus Standards: Ambulatory Care Project • Phase I (2004) – Identify priority areas • Phase II (2005) – Expedited consensus of existing ambulatory care PMs • Phase III (2005-2008) – Flesh out all 12 priority areas; four cycles

  21. National Consensus Standards for Ambulatory Care: Phase I - Priority Areas • Patient experience with care • Coordination of care • Asthma • Prevention, including immunization • Medication management • Ischemic heart disease • Diabetes • Hypertension • Depression • Obesity

  22. National Consensus Standards for Ambulatory Care: Additional Priority Areas • Prenatal care • Bone conditions

  23. National Consensus Standards for Ambulatory Care: Phase II • 36physician-focusedPMs endorsed in seven priority areas (8/3/05) • 6 measures will undergo a second round of voting • 2 measures not endorsed will be re-considered in Phase 3

  24. NQF-EndorsedTM Ambulatory Care Consensus Standards • Asthma/Respiratory Illness (4) • Behavioral Health/Depression (3) • Bone Conditions (2) • Heart Disease—CAD(10), CHF (7) • Hypertension (2) • Prenatal Care (2) • Prevention, Immunization, and Screening (6)

  25. NQF-EndorsedTM Ambulatory Care Consensus Standards • Asthma/Respiratory Illness • Asthma assessment • Asthma: pharmacologic therapy • Appropriate treatment for children with upper respiratory infection • Appropriate testing for children with pharyngitis

  26. NQF-EndorsedTM Ambulatory Care Consensus Standards • Behavioral Health/Depression • Optimal practitioner contacts for medication management • Effective acute phase treatment • Effective continuation phase treatment • Bone Conditions • Osteoarthritis: assessment for use of anti-inflammatory or analgesic over-the-counter medications • Osteoarthritis: functional and pain assessment

  27. NQF-EndorsedTM Ambulatory Care Consensus Standards • Heart Disease—Coronary artery disease • Symptoms and activity • Cholesterol screen • Lipid profile • Drug therapy for lowering low-density lipoprotein (LDL) cholesterol • Cholesterol control • LDL cholesterol level • Anti-platelet therapy • Beta blocker therapy–prior myocardial infarction • ACEI/ARB therapy • Smoking cessation and smoking cessation intervention

  28. NQF-EndorsedTM Ambulatory Care Consensus Standards • Heart Disease—Congestive heart failure • Left ventricular function (LVF) assessment • Weight measurement • Assessment of clinical symptoms of volume overload • Assessment of activity level • Beta blocker therapy • ACEI/ARB therapy • Warfarin therapy for patients with atrial fibrillation

  29. NQF-EndorsedTM Ambulatory Care Consensus Standards • Hypertension • Plan of care • Controlling high blood pressure • Prenatal Care • Anti D immune globulin • Screening for human immunodeficiency virus (HIV)

  30. NQF-EndorsedTM Ambulatory Care Consensus Standards • Prevention, Immunization, and Screening • Tobacco use and tobacco cessation • Advising smokers to quit, discussing smoking cessation medication, and discussing smoking cessation strategies • Discussing urinary incontinence and receiving urinary incontinence treatment • Flu shot for older adults and flu shot for adults ages 50-64 years • Influenza vaccination • Pneumonia vaccination

  31. Phase II Measures in 2nd Round of Voting • Use of appropriate medications for people with asthma • Coronary artery disease: Beta-blocker treatment after a heart attack • Childhood immunization • Breast cancer screening • Colorectal cancer screening • Cervical cancer screening

  32. National Consensus Standards for Ambulatory Care: Phase III • Cycle 1 (Fall 2005): care coordination, medication management, obesity, asthma, hypertension, prevention • Cycle 2 (Spring 2006): patient experience with care, heart disease, bone conditions, prenatal care, behavioral health, diabetes

  33. National Consensus Standards for Ambulatory Care: Phase III • Cycle 3 (2006-2007): special ambulatory settings of care (i.e., ambulatory surgical centers) • Cycle 4 (2007-2008): development of index/composite measures

  34. National Consensus Standards for Ambulatory Care: Project Deliverables • Sets of endorsed consensus standards • Recommendations for implementation and research issues for each set. • Commissioned background paper on barriers to small group (< 5), provider-level implementation • Index(es)/composite(s) for ambulatory care measurement and reporting. • Workshop to guide ambulatory care measurement research, development, and testing

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