In an effort to identify providers who deliver high quality care at the lowest cost, the National Quality Forum last week endorsed four new efficiency measures, which in time could end up as part of a health plan's or Medicare's value-based purchasing incentive payment formula.
This brings the total number of efficiency, or "resource use" measures to eight.
The four new measures establish the types of settings and services, measured as standard units of resources, that are appropriate to evaluate the cost of treating four conditions:
- an episode of asthma
- chronic obstructive pulmonary disease
- a hip or knee replacement procedure
- pneumonia
The measure also includes consideration of which age groups should be included in the cost analysis, and may include a dollar amount, allowable charges, or standard prices for each resource unit typically used to provide that particular type of care. A range of costs for each of these four patient conditions or episodes of care was not provided in this round of resource use measures.
For example, for asthma, the committee looked at costs incurred for inpatient or ambulatory services, such as evaluation and management, procedures and surgeries, imaging, and diagnostic care, laboratory, and admissions and discharges, the emergency department, pharmacy, evaluation and management, procedures and surgeries, laboratory and imaging, and diagnostic care.
The NQF earlier this month published an Endorsement Summary produced that explained, "Several provisions in recent policy require use of resource use data over the next several years to support efforts to move toward a value-based purchasing payment model.
"Furthermore, making quality care more affordable by developing and spreading new healthcare delivery models is one of the National Quality Strategy’s priorities. Understanding resource use measurement as a building block toward measuring efficiency and value is a critical step toward achieving these aims."
One of those recent policies requiring a harder look at resource use is the Affordable Care Act, which directs the Secretary of Health and Human Services to ensure that measures included in value-based purchasing incentive payments include a provision for efficiency, including "Medicare spending per beneficiary," adjusted for "age, sex, race, severity of illness and other factors that the Secretary determines appropriate," the NQF summary explained.
The National Quality Forum committee endorsed these four mechanisms for evaluating cost per episode of care on contract from HHS.
In a statement, NQF president and CEO Janet Corrigan said "Healthcare spending in the United States continues to rise without any significant gains in patient satisfaction, increased access to care, or higher quality care. I'm confident that these additional measures—in conjunction with existing resource use measures in our portfolio—will help us better understand what is driving costs and create a more effective, efficient healthcare system."
The four new measures follow the endorsement in January of the first four under this contract. Those are:
- Relative resource use for people enrolled in health plans and who have either type I or type II diabetes
- Relative resource use for people enrolled in health plans who have specific cardiovascular conditions including major cardiac events such as acute myocardial infarction, coronary artery bypass graft surgery and percutaneous coronary interventions as well as cardiovascular-related diagnoses such as ischemic vascular disease.
- A Resource Use Index (RUI), which is a measure of a primary care provider’s risk-adjusted frequency and intensity of services used to manage patients using standardized prices. Resource use includes all resources associated with treating members, including professional, facility inpatient and outpatient, pharmacy, laboratory, radiology, ancillary, and behavioral health services.
- A total cost of care population-based PMPM Index (HealthPartners).
This index includesthe total cost index (TCI), a measure of a primary care provider’s risk-adjusted cost effectiveness at managing the population they care for using actual prices paid by the health plan. TCI includes all costs associated with treating members, including professional, facility inpatient and outpatient, pharmacy, lab, radiology, ancillary, and behavioral health services.
The NQF's endorsement of a measure, or a similar organization's endorsement, is required before a measure of care may be included on Hospital Compare or used in the value-based purchasing algorithm.