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Why Process Measures Fail to Budge 30-Day Mortality Rates

Cheryl Clark, for HealthLeaders Media, April 5, 2012

Problem Extends Beyond CMS
The problem isn't just with CMS. It rests with other quality organizations, as well, that have dragged their feet in giving more reliable heart care measure sets credence. The National Quality Forum, the organization that endorses measures that CMS and other payers use to measure quality, "is behind the times as well," Fonarow says.

"In an ideal world, you'd have a harmonized set of measures that are reflective of the current state of knowledge. They'd be most focused on those areas where there are the greatest treatment gaps and variation and disparities in care," he says.

Fonarow acknowledges that it was important for payers, especially CMS, to start measuring quality when it did. Hospitals needed to be accountable. And the movement had to start somewhere. But time has passed, and CMS needs to be clear that longer life, not process measure scores, is the more desired result.

Fonarow and Eric Peterson, MD, of Duke University School of Medicine, have been pointing out the disconnect between performance measures and outcomes since 2009, when they wrote a Commentary in the Journal of the American Medical Association.

5 Measures Proven to Reduce Mortality in Heart Failure Patients
Besides statin medications, Fonarow lists five other treatments that are proven to reduce mortality in appropriate heart failure patients, but aren't in the CMS measure sets.

  1. Giving beta blockers at discharge.
  2. Giving aldosterone antagonist medication at discharge.
  3. Offering cardiac resyncronization therapy or CRT at discharge.
  4. Implanting cardioverter defibrillators to patients at risk for sudden arrythmia or tachycardia.
  5. Giving hydralazine-nitrate combination at hospital discharge for eligible patients who are African-American.
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