[Federal Register Volume 74, Number 174 (Thursday, September 10, 2009)]
[Notices]
[Pages 46594-46603]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E9-21783]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

[HHS-XXXX-N]


Secretarial Review and Publication of the Annual Report to 
Congress Submitted by the Contracted Consensus-Based Entity Regarding 
Performance Measurement

AGENCY: Office of the Secretary of Health and Human Services, HHS.

ACTION: Notice.

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SUMMARY: This notice acknowledges the Department of Health and Human 
Services' (HHS) receipt and review of the annual report submitted to 
the Secretary and Congress by the contracted consensus-based entity 
regarding performance measurement as mandated by section 183 of the 
Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). 
The statute requires HHS to publish not later than six months after 
receiving the annual report to Congress in the Federal Register 
together with any Secretarial comments.

FOR FURTHER INFORMATION CONTACT: Patrick Conway, (202) 690-7858.

I. Background

    Rising health care costs coupled with the growing concern over the 
level and variation in quality and efficiency in the provision of 
health care raise important challenges for the United States. Congress 
mandated the Secretary of the Department of Health and Human Services 
(HHS) to contract with a consensus-based entity regarding performance 
measurement to support HHS' efforts to achieve value as a purchaser of 
high-quality, patient-centered, and financially sustainable health 
care. Section 183 of the Medicare Improvements for Patients and 
Providers Act of 2008 (MIPPA) added section 1890 to the Social Security 
Act (the Act). The statute mandates that the contract shall be 
competitively awarded for a period four years and may be renewed under 
a subsequent competitive contracting process.
    In January 2009, the competitive contract was awarded by HHS to the 
National Quality Forum (NQF) for a four year period. With respect to 
the scope of the HHS contract activities, NQF shall conduct its 
business in an open and transparent manner, provide the opportunity for 
public comment and ensure membership fees do not pose a barrier to 
participation in the scope of HHS' contract activities, if applicable.
    The HHS four-year contract with NQF includes the following major 
tasks:
    Formulation of National Strategy and Priorities for Health Care 
Performance Measurement--NQF shall synthesize evidence and convene key 
stakeholders on the formulation of an integrated national strategy and 
priorities for health care performance measurement in all applicable 
settings. NQF shall give priority to measures: That address the health 
care provided to patients with prevalent, treatment of high-cost 
chronic diseases; provide the greatest potential for improving quality, 
efficiency and patient-centered health care; and may be implemented 
rapidly due to existing evidence, standards of care or other reasons. 
NQF shall consider measures that assist consumers and patients in 
making informed health care decisions; address health disparities 
across groups and areas; and address the continuum of care across 
multiple providers, practitioners and settings.
    Implementation of a Consensus Process for Endorsement of Health 
Care Quality Measures--NQF shall implement a consensus process for 
endorsement of standardized health care performance measures which 
shall consider whether measures are evidence-based, reliable, valid, 
verifiable, relevant to enhanced health outcomes, actionable at the 
caregiver level, feasible to collect and report, and responsive to 
variations in patient characteristics such as health status, language 
capabilities, race or ethnicity, and income level and is consistent 
across types of providers including hospitals and physicians.
    Maintenance of Consensus Endorsed Measures--NQF shall establish and 
implement a maintenance process to ensure that endorsed measures are 
updated (or retired if obsolete) as new evidence is developed.
    Promotion of Electronic Health Records--NQF shall promote the 
development and use of electronic health records that contain the 
functionality for automated collection, aggregation, and transmission 
of performance measurement information.
    Focused Measure Development, Harmonization, and Endorsement Efforts 
to Fill Critical Gaps in Performance Measurement--At the request and 
direction of HHS, NQF shall complete targeted tasks to support 
performance measurement development, harmonization, endorsement and/or 
gap analysis.
    Development of a Public Web site for Project Documents--NQF shall 
develop a public Web site to provide access to project documents and 
processes. The HHS contract work is found at: http://www.qualityforum.org/projects/ongoing/hhs/.
    Annual Report to Congress and the Secretary--Under section 
1890(b)(5)(A) of the Act, by not later than March 1 of each year 
(beginning with 2009), NQF shall submit to Congress and the Secretary 
of HHS an annual report. The report shall contain a description of the 
implementation of quality measurement initiatives under the Act and the 
coordination of such initiatives with quality initiatives implemented 
by other payers; a summary of activities and recommendations from the 
national strategy and priorities for health care performance 
measurement task; and a discussion of performance by NQF of the duties 
required under the HHS contract. Due to the award of the contract to 
NQF in mid January 2009, the first annual report covers the performance 
period of January 14, 2009 to February 28, 2009.
    In March 2009, NQF submitted the annual report to Congress and the 
Secretary of HHS. Section 1890(b)(5)(B) of the Social Security Act, as 
created by section 183 of MIPPA, requires the Secretarial review of the 
annual report to Congress upon receipt and the publication of the 
report in the Federal Register together with any Secretarial comments 
not later than 6 months after receiving the report. This notice 
complies with the review and publication requirements of the statutory 
mandate.

First NQF Report to Congress and HHS Secretary

    Submitted in March 2009, the first annual report to Congress and 
the Secretary spans the period of January 14, 2009 to February 28, 
2009. The first annual report reflects six weeks post contract award. 
Given the short timeframe between the contract award and the 
requirement for the annual report, it reflects a description of the NQF 
work-to-date as of March 2009 and future plans to comply with the 
schedule of deliverables. Additional

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time under the contract will provide NQF the opportunity to report on 
its specific activities and deliverables provided to HHS in the next 
annual report and future annual reports. A copy of NQF's submission of 
the March 2009 annual report to Congress and the Secretary of HHS can 
be found at: http://www.qualityforum.org/projects/ongoing/hhs. The NQF 
annual report is reproduced in section III of this notice.

II. NQF March 2009 Annual Report

Improving Health Care Performance:
    Setting Priorities and Enhancing Measurement Capacity
    Report to Congress and the Secretary of the U.S. Department of 
Health and Human Services
    Covering the Period of January 14, 2009 to February 28, 2009

    The mission of the National Quality Forum is to improve the quality 
of American health care by setting national priorities and goals for 
performance improvement, endorsing national consensus standards for 
measuring and publicly reporting on performance, and promoting the 
attainment of national goals through education and outreach programs.
    Section 183 of the Medicare Improvements for Patients and Providers 
Act of 2008 (MIPPA) mandates a Department of Health and Human Services 
(HHS) contract with a consensus-based entity regarding performance 
measurement (Section 1890 of the Social Security Act (the Act)). The 
National Quality Forum (NQF) was awarded the HHS contract through a 
competitive contracting mechanism to serve as the consensus-based 
entity. The statute mandates the submission of an annual report to both 
Congress and the Secretary of Health and Human Services by the 
consensus-based entity awarded the HHS contract (Section 1890(b)(5)(A) 
of the Act). The statute specifically requires the Secretarial review 
of such report upon receipt and the publication of such report in the 
Federal Register together with any Secretarial comments not later than 
6 months after receiving the report (Section 1890(b)(5)(B) of the Act). 
This report was prepared by NQF. The report does not necessarily 
reflect the views of HHS. All HHS comments on this report will be 
provided at the time of its publication in the Federal Register. This 
report is part of contract number HHSM-500-2009-00010C. National 
Quality Forum, 601 Thirteenth Street, NW., Suite 500 North, Washington, 
DC 20005, Fax 202-783-3434, http://www.qualityforum.org.

Executive Summary

    There is widespread and growing awareness from all levels of 
government that health care reform is a critical component of economic 
recovery--and that reform must address health care quality, safety, 
costs, access, and disparities in care. Truly better quality of care--
care that is more effective, safe, and efficient--is an imperative for 
aiding our nation's economic recovery and making good on our commitment 
to cover the uninsured.
    Numerous efforts are under way to advance the quality improvement 
agenda. These include the pay-for-performance and pay-for-reporting 
initiatives being undertaken by public and private sector purchasers; 
public reporting of performance information by the Centers for Medicare 
& Medicaid Services (CMS), State governments, and others; quality 
oversight by regulatory, accreditation, and professional certification 
bodies; and quality improvement activities being conducted by CMS' 
quality improvement organizations (QIOs), End-Stage Renal Disease 
Network Organizations, health care providers, practitioners, and 
others.
    The overarching goal of all of our work is to improve the quality 
and affordability of health care by providing information to consumers 
and others to assist them in making more informed health care 
decisions, and to providers and practitioners to drive quality 
improvement. Measuring health care performance and then sharing those 
results with those who provide services and those who purchase and 
receive them are the cornerstones of a system that fosters not just 
incremental gains, but continued large-scale quality improvement.
    Performance information is needed to support quality improvement, 
reform payment programs to promote value, and engage patients in making 
better choices and managing their health conditions. Performance 
measurement is a key building block for improving the quality of care.
    Recognizing the need to strengthen the nation's performance 
measurement capacity, Congress included a provision within the Medicare 
Improvements for Patients and Providers Act of 2008 (PL 110-275), 
directing the Secretary of the Department of Health and Human Services 
(DHHS) to contract with a ``consensus-based entity, such as the 
National Quality Forum.'' The entity shall:
    <bullet> Synthesize evidence and convene key stakeholders to make 
recommendations, with respect to activities conducted under this Act, 
on an integrated national strategy and priorities for health care 
performance measurement in all applicable settings.
    <bullet> Provide for the endorsement of standardized health care 
performance measures.
    <bullet> Establish and implement a process to ensure that measures 
endorsed are updated (or retired if obsolete) as new evidence is 
developed.
    <bullet> Promote the development and use of electronic health 
records that contain the functionality for automated collection, 
aggregation, and transmission of performance measurement information.
    <bullet> Submit an annual report to Congress and the Secretary.
    Under the contract, DHHS has asked that measures focus on 
``outcomes and efficiencies that matter to patients, align with 
electronic collection at the front end of care, encompass episodes of 
care when possible, and be attributable to providers where possible. A 
premium must be placed on developing measures in key areas that will 
have the greatest impact in improving quality and value, rather than 
focusing on developing a large number of measures that may be easiest 
to produce, such as process measures.'' On January 14, 2009, the 
National Quality Forum (NQF) was awarded a contract that addresses and 
is responsive to Section 183 of the Medicare Improvements for Patients 
and Providers Act of 2008. The contract, which has a period of 
performance of four years, is being incrementally funded on a yearly 
basis.
    As a part of its work under the contract, NQF is required to 
produce an Annual Report to Congress by March 1 each year. Because this 
contract only recently commenced on January 14, 2009, this initial 
report to Congress provides a ``look forward.'' More specifically, it 
focuses on two areas:
    <bullet> Recent accomplishments that provide a foundation for work 
under this contract, and
    <bullet> Strategic direction and key challenges that lie ahead.

Foundation for Work: Background and Recent Accomplishments

    NQF is a not-for-profit, multi-stakeholder membership organization 
whose mission is to improve the quality of American health care by:
    <bullet> Setting national priorities and goals for performance 
improvement;
    <bullet> Endorsing national consensus standards for measuring and 
publicly reporting on performance, and on promoting the attainment of 
national goals through education and outreach programs.

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    NQF's membership includes more than 375 organizations representing 
virtually every sector of the health care system. The work to be 
conducted under this DHHS contract will directly relate to NQF's core 
competencies and recent accomplishments in three areas:
    <bullet> Setting National Priorities and Goals. NQF has convened 
leaders from major stakeholder groups and through this process has 
identified National Priorities and Goals for Performance Improvement. 
This work provides a foundation for the priority-setting efforts under 
this contract which focus on clinical conditions.
    <bullet> Endorsing performance measures. NQF's consensus 
development process has resulted in more than 400 endorsed measures.
    <bullet> Facilitating the development of electronic health records 
to support measurement and improvement. NQF has worked to identify the 
types of information that need to be included in an EHR to enable 
reporting on quality metrics.

Setting National Priorities and Goals

    The National Priorities Partnership, convened by NQF, is a 
collaborative effort of 28 major national organizations representing 
multiple stakeholders, including consumer groups, employers, 
government, health plans, health care organizations, health care 
professionals, accrediting and certifying bodies, and quality 
alliances. The Partnership set National Priorities and Goals intended 
to focus performance improvement efforts on high-leverage areas--those 
with the most potential in the near term to result in substantial 
improvements in health and health care--and thus accelerate fundamental 
change in our health care delivery system. Taking action on the high-
leverage Priorities and Goals, the Partners, individually and 
collectively, have the capacity to significantly advance health care 
reform. In November 2008, the Partnership released the results of its 
initial work in a report: National Priorities and Goals: Aligning our 
Efforts to Transform America's Health Care (see Appendix A for the 
executive summary).
    The National Priorities and Goals were selected because they 
address four major challenges: Eliminating harm, eradicating 
disparities, reducing disease burden, and eliminating waste. The 
National Priorities fall into six areas:
    <bullet> Engage patients and families in managing their health and 
making decisions about their care.
    <bullet> Improve the health of the population.
    <bullet> Improve the safety and reliability of America's health 
care system.
    <bullet> Ensure patients receive well-coordinated care within and 
across all health care organizations, settings, and levels of care.
    <bullet> Guarantee appropriate and compassionate care for patients 
with life-limiting illnesses.
    <bullet> Eliminate overuse while ensuring the delivery of 
appropriate care.
    The Partners are now developing action plans to achieve the 
National Priorities and Goals, which will entail alignment of key 
environmental drivers, such as public reporting, payment, and 
accreditation and certification programs. Learn more at http://www.nationalprioritiespartnership.org.

Endorsing Performance Measures

    Advancing quality improvements requires valid, meaningful 
measurement. Simply put, you cannot improve what you cannot measure. 
Measures make it possible to more effectively focus our quality 
improvement efforts by helping identify what is working and what needs 
additional improvement. NQF is a private sector, standard-setting 
organization, and one of its roles is to evaluate measures and select 
the ``best in class.'' Use of NQF-endorsed[supreg] measures facilitates 
making apples-to-apples comparisons.
    NQF is a voluntary consensus standard-setting organization as 
defined by the National Technology Transfer and Advancement Act of 1995 
(NTTAA) and the Office of Management and Budget Circular A-119. 
Standard-setting organizations recognized under NTTAA must comply with 
strict requirements pertaining to multi-stakeholder involvement, 
transparency of decisionmaking, and due process.
    The consensus development process (CDP) is the formal process by 
which NQF achieves consensus and endorses measures. There are seven 
steps in the endorsement process: Formation of a steering committee, 
calls for measures, measure evaluation, public comment, member voting, 
review by the consensus standards approval committee and board of 
directors, and appeals. The CDP reflects a careful process designed to 
produce consensus from disparate groups across the health care 
industry, including consumers, purchasers, providers, public and 
community health, suppliers, quality improvement and measurement 
organizations, and health plans.
    Using this process, NQF has endorsed more than 400 quality measures 
for a variety of health care settings.
    In 2008, NQF conducted consensus development projects in the 
following areas:
    <bullet> Perinatal Care;
    <bullet> Home Health Care;
    <bullet> Ambulatory Care;
    <bullet> Emergency Care;
    <bullet> Health Information Technology;
    <bullet> Hospital Care;
    <bullet> Immunization;
    <bullet> Outpatient Imaging.
    Much of the support for these projects was provided by CMS and the 
Agency for Health care Research and Quality (AHRQ), as well as private 
foundations.

Facilitating the Development of Electronic Health Records To Support 
Measurement and Improvement

    NQF also serves as an important ``bridge'' between the quality and 
health information technology communities to facilitate the development 
of electronic health records (EHRs) and personal health records (PHRs) 
that are capable of supporting performance measurement, reporting, and 
improvement. That work has two objectives. First, performance measures 
need to have turnkey measurement specifications that allow ready 
incorporation directly into EHRs and PHRs. Second, EHRs and PHRs must 
be able to capture the necessary data and possess the necessary 
functionality to calculate and report the performance information and 
provide the associated clinical decision-support to practitioners to 
improve performance.
    NQF's Health Information Technology Expert Panel (HITEP), funded 
with support from AHRQ, produced its first report in January 2009 
Recommended Common Data Types and Prioritized Performance Measures for 
Electronic Health Care Information Systems (see Appendix B for the 
executive summary). This report identifies the types of data that must 
be captured in EHRs to calculate the performance measures that are 
currently used by Medicare for public reporting purposes. Through its 
measure endorsement process, NQF is working with measure developers to 
encourage the adoption of common conventions for specifying measures 
that will make it easier for vendors to build EHRs and PHRs capable of 
calculating the measures and providing the associated clinical 
decision-support to assist providers in improving their performance. 
HITEP is now working closely with the DHHS Office of the National 
Coordinator to ensure that the ``Quality Data Set''--the types of data 
that need to be captured in EHRs and PHRs to support quality 
measurement and performance improvement--gets translated into health 
information technology standards, which in turn

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become requirements for EHR certification by the Certification 
Commission for Health Information Technology.

Strategic Direction and Challenges Ahead

    NQF has for many years received federal support, primarily in the 
form of grants and contracts for very specific projects (e.g., a 
project to review physician-level measures related to cancer care). 
This new DHHS contract supports development and execution of a 
comprehensive, multi-year work plan for performance measurement. This 
contract will bolster, very significantly, six key functions of the 
quality measurement infrastructure.
    Further Enhance the National Priorities and Goals. The current set 
of National Priorities and Goals represents cross-cutting areas that 
apply to all or many patients and conditions, like safety and care 
coordination. Over the coming year, a prioritized list will be 
developed of the top 20 conditions that account for 90 percent of 
Medicare costs, based on various criteria, including health and cost 
burden and opportunity for improvement. This two-dimensional 
framework--cross-cutting areas and conditions--will be used to focus 
the work of both NQF and other key players to achieve rapid 
improvement.
    Building Measure Sets for Patient-Focused Episodes. Over the coming 
two to three years, measure sets will be identified for each of the top 
20 conditions that include measures of the health care process (e.g., 
effectiveness and safety measures), patient engagement, in decision 
making, patient outcomes, and cost. This framework moves the 
measurement field from a focus on the provision of individual services 
provided in one setting to an ``episode'' view that fosters patient 
engagement care coordination, efficiency, and accountability for 
outcomes.
    Identify Critical Gaps in Measures. Measures will be needed to 
gauge progress in meeting the National Priorities and Goals, and 
efforts are now under way to identify gaps in the portfolio of NQF-
endorsed measures. The mapping of available measures to conditions/
patient-focused episodes will also reveal gaps.
    Identify Areas for New Measure Development. Based on the ``gap 
analysis'' discussed above, an environmental scan will be conducted to 
determine if measures are available for endorsement or whether new ones 
need to be developed and which measures may be of most importance to 
the Medicare, Medicaid, or CHIP populations. There is also a 
significant need to identify where composite measures (combinations of 
two or more individual measures to produce an overall score) should be 
developed to provide an overall indication of performance in particular 
areas (e.g., preventive services, safety).
    Measure Maintenance and Retooling. The ability to examine measures 
on an ongoing basis with built-in requirements for regular measure 
maintenance helps ensure that the best measures are available for 
public reporting, health care performance assessment, and quality 
improvement. Performance measures must be maintained to reflect new 
clinical evidence, as well as ``lessons learned'' from their use in the 
field. NQF requires that measures undergo maintenance on a three-year 
cycle, or sooner if necessary. There is also a critical need to retool 
measures to run off of electronic data sources (e.g., EHRs, 
administrative data, registries).
    Further Strengthen Relationships Between the Quality Community and 
the Health Information Technology Community. NQF will foster ongoing 
communication and collaboration between the performance measurement 
community and the health information technology community, and ensure 
proper coordination of standard-setting activities that occur in the 
quality community (e.g., standards related to clinical concepts, 
performance measure logic, and performance measure specifications) and 
standard-setting activities that occur in the HIT community (e.g., EHR 
standards for data capture, data transmission protocols).
    The goals of this contract will also support key HHS work outlined 
in the recently enacted American Recovery and Reinvestment Act of 2009 
(ARRA) in three important ways.
    <bullet> Work will support the health information technology (HIT) 
provisions of the ARRA by facilitating communications between the HIT 
and quality communities to ensure that electronic health records (EHRs) 
and personal health records (PHRs) possess the necessary capabilities 
to support performance measurement, reporting and improvement. NQF's 
work will be of relevance to both of the HIT Policy and Standards 
Committees that will be established under this law.
    <bullet> The prevention provisions of ARRA call for strategies to 
reduce health care-associated infections and to enhance chronic disease 
outcomes. Through the priority-setting process, the NQF contract will 
focus performance improvement activities on these areas, and will 
identify standardized performance measures that can be used for public 
reporting and to assess the effectiveness of these programs.
    <bullet> The comparative effectiveness research program of ARRA 
will provide new evidence on what treatments work and do not work to 
inform providers and consumers to use the best care available. Through 
its priority-setting and endorsement processes, NQF will likely 
identify key gaps in the evidence base, and this information will be 
shared with the comparative effectiveness program to help guide its 
agenda-setting activities.

Conclusion

    Health care is going through a period of extraordinary change with 
efforts aimed at major reform of the health system. NQF is working 
closely with DHHS to ensure that the work under this contract provides 
the greatest value and support for health care reform that will give 
more people access to high quality, affordable health care.
    This new contract will produce tangible benefits that are critical 
to establishing the measurement and reporting infrastructure necessary 
to achieve broader health reform objectives. Identifying national 
priorities for performance improvement, and measuring and reporting on 
the performance of health plans, health care providers, and 
practitioners against robust uniform national standards, will provide 
the needed foundation for achieving better patient outcomes, improved 
patient experience, and more affordable health care.
    This contract will help establish a comprehensive portfolio of 
quality and efficiency measures that will allow the federal government 
to more clearly see how and whether health care spending is achieving 
the best results for patients and taxpayers, strengthening a core 
building block of the nation's capacity to provide high-value health 
care.

Appendix A--Report of the National Priorities Partnership National 
Priorities and Goals: Aligning our Efforts To Transform America's 
Health care (Executive Summary)

The Partners & Acknowledgements
The Partners
    Donald Berwick, Co-chair President and CEO, Institute for Health 
Care Improvement
    Margaret O'Kane, Co-chair President, National Committee for Quality 
Assurance
    Leah Binder, Chief Executive Officer, Leapfrog Group
    Christine Cassel, President and CEO, American Board of Internal

[[Page 46598]]

Medicine Representing the American Board of Medical Specialties
    Mark Chassin, President, The Joint Commission
    Carolyn Clancy, Director, Agency for Health Care Research and 
Quality
    Janet M. Corrigan, President and CEO, National Quality Forum
    Helen Darling, President, National Business Group on Health
    Steven Findlay, Managing Editor, Consumer Reports Best Buy Drugs, 
Consumers Union
    Roger Herdman, Director, National Cancer Policy Forum and Board on 
Health Care Services, Institute of Medicine
    Julie Gerberding, Director, Centers for Disease Control and 
Prevention
    George Isham, Medical Director and Chief Health Officer, 
HealthPartners Representing America's Health Insurance Plans
    Peter V. Lee, Executive Director, National Health Policy, Pacific 
Business Group on Health
    Marlene Miller, Vice Chair, Quality and Safety, Johns Hopkins 
Children's Center Representing the Alliance for Pediatric Quality
    Mark McClellan, Director, Engelberg Center for Health Care Reform, 
Brookings Institution
    Elizabeth Nabel, Director, National Heart, Lung, and Blood 
Institute, National Institutes of Health
    Debra L. Ness, President, National Partnership for Women & Families
    Frank Opelka, Vice-Chancellor of Clinical Affairs, Health Sciences 
Center, Louisiana State University Representing AQA
    Alisa Ray, Executive Director, Certification Commission for Health 
Care Information Technology
    Bernard Rosof, Chair, Physician Consortium for Performance 
Improvement
    John Rother, Executive Vice President, Policy and Strategy, AARP
    Raymond Scheppach, Executive Director, National Governors 
Association
    Gerald Shea, Assistant to the President for External Affairs, AFL-
CIO
    David M. Stevens, Director, Quality Center, National Association of 
Community Health Centers
    Linda J. Stierle, Chief Executive Officer, American Nurses 
Association
    Barry Straube, Director and Chief Medical Officer, Centers for 
Medicare & Medicaid Services
    Richard J. Umbdenstock, President and CEO, American Hospital 
Association Representing the Hospital Quality Alliance
    Anthony Wisniewski, Executive Director, Health Care Policy, U.S. 
Chamber of Commerce

Key Staff
    Karen Adams, Vice President, National Priorities
    Alicia Aebersold, Vice President, Communications
    Nadine Allen, Administrative Assistant
    Anisha Dharshi, Program Director
    Rebecca Fleischauer, Media Campaign Coordinator
    Amy Stern, Senior Director, National Priorities Outreach Efforts
    Wendy Vernon, Senior Program Director, National Priorities
Acknowledgements
    An undertaking as complex and visionary as setting National 
Priorities and Goals for the nation clearly requires much thought, much 
expertise, much knowledge, and much work. The Partners first wish to 
acknowledge all of the reports and research and all of the efforts of 
the commissions and study groups that preceded and informed our work, 
many of which the reader can find in the references. We humbly 
recognize that our work stands on the shoulders of hundreds of 
brilliant people, both from within and outside of the health care 
arena, who are working every day to improve the way we deliver care. 
They cannot possibly all be listed, but their contributions are more 
than significant.
    The Partners divided into a number of working groups to accomplish 
the work of the Partnership. We wish to thank the following experts who 
contributed significantly to our deliberations: Stephanie Alexander 
(Premier, Inc.), Carmella Bocchino (America's Health Insurance Plans), 
Kent Bottles (Institute for Clinical Systems Improvement), Maureen 
Corry (Childbirth Connection), Jay Crosson (Council of Accountable 
Physician Practices), Rita Munley Gallagher (American Nurses 
Association), Lea Anne Gardner (American College of Physicians), Paul 
Gitman (North Shore Long Island Jewish Health System), Trent Haywood 
(VHA, Inc.), Richard Hellman (American Association of Clinical 
Endocrinologists), Ronald A. Henrichs (American Academy of 
Dermatology), Michelle Johnston-Fleece (American Board of Internal 
Medicine), Norman Kahn (Council of Medical Specialty Societies), David 
Kindig (University of Wisconsin-Madison, School of Medicine), Jerod 
Loed (The Joint Commission), Michael Maciosek (HealthPartners Research 
Foundation), John Mastrojohn III (National Hospice and Palliative Care 
Organization), Kristen McNiff (American Society of Clinical Oncology), 
Diane Meier (Center To Advance Palliative Care), David Meyers (Agency 
for Health Care Research and Quality), Sean Morrison (National 
Palliative Care Research Center), Naomi Naierman (American Hospice 
Foundation), Harvey Neiman (American College of Radiology), Marsha 
Nelson (American Hospice Foundation), Lee Partridge (National 
Partnership for Women and Families), Robert Plovnick (American 
Psychiatric Association), Leif Solberg (HealthPartners Research 
Foundation), James Tulsky (Duke University, Center for Palliative 
Care), Margaret Van Amringe (The Joint Commission), and W. Douglas 
Weaver (American College of Cardiology). We wish to thank Michael Lauer 
(National Institutes of Health), Brad Perkins (Centers for Disease 
Control and Prevention), and Ed Sondik (Centers for Disease Control and 
Prevention) for their many contributions to this effort in support of 
their respective primary representatives on the Partnership.
    We also would like to acknowledge the contributions of National 
Quality Forum Members for their input on the determination of the 
priorities and their concerted efforts to improve care coordination. 
Special thanks go to the chairs of the National Quality Forum Member 
Councils, including Paul Convery (Baylor Health Care System), Louis 
Diamond (Thomson Reuters), David Domann (Johnson and Johnson Health 
Care Systems), David Gifford (Rhode Island Department of Health), 
Robert Haralson (American Academy of Orthopaedic Surgeons), Christine 
Izui (BlueCross BlueShield Association), Brian Lindberg (Consumer 
Coalition for Quality Health Care), and Andrew Webber (National 
Business Coalition on Health). Dwight McNeill, Vice President for 
Education and Outreach, deserves recognition for his leadership of 
these efforts. We wish to acknowledge the input from the following NQF 
member nursing associations as well as the broader nursing community: 
American Nurses Association (ANA), American Association of Nurse 
Anesthetists, American Academy of Nursing, American Association of 
Colleges of Nursing, Hartford Institute for Geriatric Nursing, Infusion 
Nurses Society, American Organization of Nurse Executives, Hospice and 
Palliative Nurses Association, AORN (the Association of periOperative 
Nurses), Academy of Medical-Surgical Nurses, American College of Nurse-
Midwives,

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Association of Women's Health, Obstetric and Neonatal Nurses, National 
Council of State Boards of Nursing, and the American Psychiatric Nurses 
Association. The National Quality Forum staff teams contributed 
tirelessly to this effort, led by Karen Adams, Vice President of 
National Priorities, and Alicia C. Aebersold, Vice President of 
Communications. We wish to recognize the hard work of Nadine Allen, 
Ciarra Day, Stacy Fiedler, Sands Hakimi, Sara Maddox, Jeff Patyk, Bryan 
Pruitt, Dan Rafter, Mariam Rauf, Leslie Reeder-Thompson, Amy Stern, and 
Katharine Torrey. Special thanks to Wendy Vernon and Rebecca 
Fleischauer, who did a remarkable job drafting and editing significant 
sections of the report. And to Anisha Dharshi for her support of the 
working groups and her meticulous proofing of the final report. We wish 
to thank Helen Burstin, Senior Vice President of Performance 
Measurement for her guidance throughout this process, her service to 
the working groups, and her many contributions to the content and 
editing of this report.
    Thanks also to Suzanne Benoit, Gregg Roby Burrage, Susan Guyre, and 
Marjorie Tucker-Pfeiffer at Rings Leighton for their patience and skill 
in producing the report, and to the teams at GYMR and MS&L for their 
support in the overall effort.
    Finally, the National Priorities Partnership acknowledges the 
generous support from the Robert Wood Johnson Foundation, whose vision 
for the future of America's health care gave us the freedom to imagine 
a destination for our nation that is both aspirational and achievable. 
We wish to thank Anne Weiss for her invaluable guidance and support for 
this initiative and Minna Jung, a communications strategist and guide 
of the highest caliber.
Executive Summary
National Priorities and Goals: Aligning Our Efforts To Transform 
America's Health Care
    The promise of our health care system is to provide all Americans 
with access to health care that is safe, effective, and affordable. But 
our system as it is today is not delivering on that promise. In recent 
years, we have seen remarkable efforts that demonstrate how well health 
care organizations can do in delivering on this promise, but these 
examples stand out because they are the exception, not the norm. To 
improve our results, we must fundamentally change the ways in which we 
deliver care, and this will require focused and combined efforts by 
patients, health care organizations, health care professionals, 
community members, payers, suppliers, government organizations, and 
other stakeholders. The National Priorities Partnership--a 
collaborative effort of 28 major national organizations that 
collectively influence every part of the heath care system--is doing 
just that. The Partners, convened by the National Quality Forum to 
address the challenges of our health care system, represent multiple 
stakeholders drawn from the public and private sectors. These 
organizations believe that it will require the work of many to achieve 
the transformational change that is needed for the United States to 
have a high-performing, high-value health care system. Recent economic 
events, including instability of the U.S. economy and what appears to 
be a wide and deep recession, make addressing our health care problems 
even more urgent. Many Americans have seen their retirement savings 
decline markedly, and millions of others have lost their homes and 
jobs. It is clear that the health care status quo is unsustainable. 
Health care spending accounts for 16 percent of the GDP (gross domestic 
product) and is increasing at an average annual rate of around 7 
percent. Americans spend more per capita on health care than any other 
industrialized country, yet our results on many important indicators of 
quality fall significantly below those of similar nations. The time for 
serious and transformational change is now. As a first step, the 
Partners have identified a set of National Priorities and Goals to help 
focus performance improvement efforts on high-leverage areas--those 
with the most potential to result in substantial improvements in health 
and health care--and thus accelerate fundamental change in our health 
care delivery system.
The National Priorities and Goals
    The National Priorities and Goals were selected because they 
collectively and individually address four major challenges--
eliminating harm, eradicating disparities, reducing disease burden, and 
removing waste--that are important to every American. Six Priority 
areas have been identified in which the Partners believe our combined 
and collective efforts can have the most impact. While the Goals are 
aspirational, the success of many small scale improvement projects 
offers direction on how we might proceed to bring this to scale 
nationally.
Engage Patients and Families in Managing Their Health and Making 
Decisions About Their Care
    We envision health care that honors each individual patient and 
family, offering voice, control, choice, skills in self-care, and total 
transparency, and that can and does adapt readily to individual and 
family circumstances, and differing cultures, languages and social 
backgrounds. The Partners will work together to ensure that: All 
patients will be asked for feedback on their experience of care, which 
health care organizations and their staff will then use to improve 
care. All patients will have access to tools and support systems that 
enable them to effectively navigate and manage their care. All patients 
will have access to information and assistance that enables them to 
make informed decisions about their treatment options.
Improve the Health of the Population
    We envision communities that foster health and wellness as well as 
national, state, and local systems of care fully invested in the 
prevention of disease, injury, and disability--reliable, effective, and 
proactive in helping all people reduce the risk and burden of disease.
    The Partners will work together to ensure that: All Americans will 
receive the most effective preventive services recommended by the U.S. 
Preventive Services Task Force. All Americans will adopt the most 
important healthy lifestyle behaviors known to promote health. The 
health of American communities will be improved according to a national 
index of health.
Improve the Safety and Reliability of America's Health Care System
    We envision a health care system that is relentless in continually 
reducing the risks of injury from care, aiming for ``zero'' harm 
wherever and whenever possible--a system that can promise absolutely 
reliable care, guaranteeing that every patient, every time, receives 
the benefits of care based solidly in science. We envision health care 
leaders and health care professionals intolerant of defects or errors 
in care, and who constantly seek to improve, regardless of their 
current levels of safety and reliability. The Partners will work 
together to ensure that:
    All health care organizations and their staff will strive to ensure 
a culture of safety while driving to lower the incidence of health 
care-induced harm, disability, or death toward zero. They will focus 
relentlessly on continually reducing and seeking to eliminate all

[[Page 46600]]

health care-associated infections (HAI) and serious adverse events. 
Health care-associated infections include, but are not limited to:

Catheter-associated blood stream infections
Catheter-associated urinary tract infections
Surgical site infections
Ventilator-associated pneumonia

    (See the Centers for Disease Control and Prevention's Infectious 
Diseases in Health Care Settings for a more inclusive list.)
    Serious adverse events include, but are not limited to:

Pressure ulcers
Wrong site surgeries
Falls Air embolisms
Blood product injuries
Foreign objects retained after surgery

    Adverse drug events associated with high alert medications (See the 
National Quality Forum's Serious Reportable Events for a more inclusive 
list.)
    All hospitals will reduce preventable and premature hospital-level 
mortality rates to best-in-class.
    All hospitals and their community partners will improve 30-day 
mortality rates following hospitalization for select conditions (acute 
myocardial infarction, heart failure, pneumonia) to best-in-class.
Ensure Patients Receive Well-Coordinated Care Within and Across All 
Health Care Organizations, Settings, and Levels of Care
    We envision a health care system that guides patients and families 
through their health care experience, while respecting patient choice, 
offering physical and psychological supports, and encouraging strong 
relationships between patients and the health care professionals 
accountable for their care. The Partners will work together to ensure 
that: Health care organizations and their staff will continually strive 
to improve care by soliciting and carefully considering feedback from 
all patients (and their families when appropriate) regarding 
coordination of their care during transitions.
    Medication information will be clearly communicated to patients, 
family members, and the next health care professional and/or 
organization of care, and medications will be reconfirmed each time a 
patient experiences a transition in care.
    All health care organizations and their staff will work 
collaboratively with patients to reduce 30-day readmission rates. All 
health care organizations and their staff will work collaboratively 
with patients to reduce preventable emergency department visits.
Guarantee Appropriate and Compassionate Care for Patients With Life-
Limiting Illnesses
    We envision health care capable of promising dignity, comfort, 
companionship, and spiritual support to patients and families facing 
advanced illness or dying, fully in synchrony with all of the resources 
that community, friends, and family can bring to bear at the end of 
life.
    The Partners will work together to ensure that: All patients with 
life-limiting illnesses will have access to effective treatment for 
relief of suffering from symptoms such as pain, shortness of breath, 
weight loss, weakness, nausea, serious bowel problems, delirium, and 
depression.
    All patients with life-limiting illnesses and their families will 
have access to help with psychological, social, and spiritual needs.
    All patients with life-limiting illnesses will receive effective 
communication from health care professionals about their options for 
treatment; realistic information about their prognosis; timely, clear, 
and honest answers to their questions; advance directives; and a 
commitment not to abandon them regardless of their choices over the 
course of their illness.
    All patients with life-limiting illnesses will receive high-quality 
palliative care and hospice services.
Eliminate Overuse While Ensuring the Delivery of Appropriate Care
    We envision health care that promotes better health and more 
affordable care by continually and safely reducing the burden of 
unscientific, inappropriate, and excessive care, including tests, 
drugs, procedures, visits, and hospital stays.
    The Partners will work together to ensure that:
    All health care organizations will continually strive to improve 
the delivery of appropriate patient care, and substantially and 
measurably reduce extraneous service(s) and/or treatment(s).
    The recommended areas of concentration are as follows:

Inappropriate medication use, targeting:
    Antibiotic use
    Poly pharmacy (for multiple chronic conditions; of antipsychotics)
Unnecessary laboratory tests, targeting:
    Panels (e.g., thyroid, SMA 20)
    Special testing (e.g., Lyme Disease with regional considerations)
Unwarranted maternity care interventions, targeting:
    Cesarean section
Unwarranted diagnostic procedures, targeting:
    Cardiac computed tomography (noninvasive coronary angiography and 
coronary calcium scoring)
    Lumbar spine magnetic resonance imaging prior to conservative 
therapy, without red flags
    Uncomplicated chest/thorax computed tomography screening Bone or 
joint x-ray prior to conservative therapy, without red flags Chest x-
ray, preoperative, on admission, or routine monitoring Endoscopy
Inappropriate non-palliative services at end of life, targeting:
    Chemotherapy in the last 14 days of life
    Aggressive interventional procedures
    More than one emergency department visit in the last 30 days of 
life
Unwarranted procedures, targeting:
    Spine surgery
    Percutaneous transluminal
    coronary angioplasty (PTCA)/Stent
    Knee/hip replacement Coronary artery bypass graft (CABG)
    Hysterectomy
    Prostatectomy
Unnecessary consultations Preventable emergency department visits and 
hospitalizations, targeting:
    Potentially preventable emergency department visits
    Hospital admissions lasting less than 24 hours
    Ambulatory care sensitive conditions
Potentially harmful preventive services with no benefit, targeting:
    BRCA mutation testing for breast and ovarian cancer--female, low 
risk
    Coronary heart disease (CHD): Screening using electrocardiography, 
exercise treadmill test, electron beam computed tomography--adults, low 
risk
    Carotid artery stenosis screening--general adult population
    Cervical cancer screening--female over 65, average risk and female, 
post-hysterectomy
    Prostate cancer screening--male over 75 (From the U.S. Preventive 
Services Task Force D Recommendations List)vi
The Path Forward
    Identifying a starter set of National Priorities and Goals is a 
major accomplishment, but it is only the first step in what must be a 
more expansive and ongoing implementation aimed at achieving the 
performance goals. Over the next year and beyond, we hope the National 
Priorities and Goals will spur action and innovation, because without 
coordinated actions, these goals will not be reached. The Partners have 
agreed to work with each other and with

[[Page 46601]]

policymakers, health care leaders, and the community at large, to build 
on the framework provided in this report, and to develop actions in 
each of the major areas that will drive improvements needed: 
Performance measurement, public reporting, payment systems, research 
and knowledge dissemination, professional development, and system 
capacity.
    Health care reform is well under way and the current economic 
crisis makes solving the puzzles of quality, equity, and value not just 
an ideal, but an imperative. The National Priorities Partnership is 
encouraging everyone to join not in calling for reform, but in enacting 
it nationally and in local communities across the country. The mere 
existence of a shared sense of responsibility to meet specific goals 
can transform health care quality. Acting to meet them can 
revolutionize it.
    i. Catlin A, Cowan C, Heffler S, et al., National health spending 
in 2005: The slowdown continues. Health Aff, 2007;26(1):142-153.
    ii. The Commonwealth Fund, ``Why Not the Best? Results from the 
National Scorecard on U.S. Health System Performance, 2008''.
    iii. Centers for Disease Control and Prevention, Infectious Disease 
in Health care Settings. Available at http://www.cdc.gov/ncidod/dhqp/id.htm.
    iv. National Quality Forum, Serious Reportable Events. Available at 
http://www.qualityforum.org/projects/completed/srz/fact-sheet.asp.
    v. ``Best-in-class'' may be determined by using an accepted 
methodology, such as Achievable Benchmarks in Care (ABC)<SUP>TM</SUP>.
    vi. Agency for Health care Research and Quality, U.S. Preventive 
Services Task Force (USPSTF). Available at http://www.ahrq.gov/clinic/prevenix.htm.
    The time for serious and transformational change is now.--The 
National Priorities Partnership

Appendix B--Report of the Health Information Technology Expert Panel: 
Recommended Common Data Types and Prioritized Performance Measures for 
Electronic Health Care Information Systems (Executive Summary)

    As described in the Institute of Medicine's (IOM's) Crossing the 
Quality Chasm report, the quality of health care in the United States 
is substantially lacking in many pivotal areas. Complex care is 
typically uncoordinated, and important information is frequently 
unavailable when needed by providers. Consequently, unexplained 
variations in the delivery of health care and the underuse, overuse, 
and misuse of health care products and services pervade the system, 
compromising the quality of American medicine and jeopardizing the 
health of its recipients.
    Measuring quality is a first step toward improving American health 
care. Currently, however, collecting and reporting accurate, 
comparative health care performance data is complex and largely a time-
consuming, manual process. Quality improvement leaders have long 
recognized that the widespread adoption of health information 
technology (HIT) will automate and simplify these processes by 
providing electronic information. Yet, to date, most of the electronic 
health information readily available for quality measurement has been 
administrative, claims-based data, which include only limited clinical 
information.
    Electronic health record (EHR) systems have been identified as a 
fundamental HIT tool for collecting high-quality electronic clinical 
information. The federal government and private sector leaders have 
increased efforts to expedite and encourage the widespread adoption of 
HIT by health care providers; yet significant barriers prevent the 
collection of needed quality information within the EHR. To compare 
performance nationally, all quality indicators need to measure the same 
concepts and speak the same language in order to consistently and 
reliably measure quality.
    Although there is no dearth of HIT standards, such standards do not 
exist when defining quality metrics (e.g., the definition of diabetes 
may be interpreted differently by different institutions). This lack of 
a set of precisely defined, universally adopted clinical definitions is 
an obstacle to measuring and comparing quality.
    To address the need for standardization of health care quality 
measurement, the American Health Information Community (AHIC), an 
advisory committee to the Secretary of the Department of Health and 
Human Services (DHHS), established a Quality Workgroup to define how 
HIT can evolve to effectively support performance measurement. The 
workgroup recommended that an HIT expert panel be convened in order to 
accelerate ongoing efforts in this standardization process. The 
National Quality Forum (NQF) was commissioned by the Agency for Health 
care Research and Quality (AHRQ) to assemble and convene the expert 
panel and to provide a detailed account of its conclusions and 
recommendations. The NQF Health Information Technology Expert Panel 
(HITEP) members (Appendix A) were selected to ensure broad 
representation across the fields of quality measurement and HIT and of 
EHR vendors, health systems, and government organizations. With the 
goal of achieving automated quality measurement, the panel was charged 
with the following tasks:
    1. Establish a priority order for the current sets of AQA 
Alliance--and Hospital Quality Alliance--approved measures;
    2. Identify common data types from the subset of highest priority 
measures to be standardized for automation in EHRs and health 
information exchanges; and
    3. Develop an overarching quality measure development framework to 
facilitate developing, using, and reporting on quality measures from 
EHR systems.
    To prioritize measures for immediate attention, the panel used the 
IOM's priority conditions. Next, the panel identified the common data 
types (e.g., outpatient diagnosis, laboratory result, medication order) 
required by these high-priority measures. The panel then developed a 
set of criteria (e.g., level of data standardization, accuracy of data 
source) to assess the quality of each data type as it currently exists 
in EHRs. Each data type received a summary quality score from these 
criteria. Because measures are composed of numerous data types, the 
panel calculated overall scores for each measure as the average quality 
of its individual data types. This overall measure score can be used to 
assess a measure's readiness for EHR implementation and to focus 
efforts to improve (or replace) low-scoring measures and low-scoring 
data types. Although the work of HITEP was to establish an initial 
prioritization of measures and their associated data types, further 
data types should be identified as additional priorities and measures 
are developed.
    A key product of the HITEP meetings, a list of common data types 
(i.e., diagnoses, laboratories, medications), was submitted to the 
Health Information Technology Standards Panel (HITSP) for the selection 
of standard terminologies, or code sets (i.e., ICD-9, LOINC, SNOMED), 
to express these data types. These computerized terminologies, 
identified in the HITSP Quality Interoperability Specification version 
1.0, will support efforts for universal adoption of standardized 
performance measures in EHRs. Active engagement of standard development 
organizations by HITSP will aid in closing the gap between the quality 
and information technology enterprises. Additional

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recommendations for EHR functionality will be submitted to the 
Certification Commission for Health Care Information Technology (CCHIT) 
for consideration in future certification criteria.
    HITEP identified three broad requirements to improve the quality 
measurement information technology enterprise and suggested 
recommendations to CCHIT, HITSP, measure development organizations 
(MDOs), NQF, EHR vendors, and the HL7 EHR Technical Committee. First, 
quality measures should be designed to leverage the capabilities of 
EHRs. MDOs and NQF should work together to reinforce the use of high-
quality data types during measure development and endorsement of 
measures into consensus national standards. Second, standard 
terminologies should be identified to code the common data types used 
in quality measure definitions. Finally, quality measure clinical 
information should be accurately captured in EHRs. Quality and 
information technology stakeholders should work with EHR vendors to 
develop functional criteria for software needed to capture the common 
data required for quality measurement.

Appendix C--Overview of the Tasks of the Contract

    The contract consists of twelve tasks. The first five tasks involve 
overall contract management and include the development of a work plan 
and an internal quality assurance evaluation plan. A detailed work plan 
for the first year of the contract activities is under way. Tasks six 
through twelve represent the work of the contract. A brief synopsis of 
each task is provided below.
Task 6: Formulation of National Strategy and Priorities for Health Care 
Performance Measurement
    NQF will synthesize evidence and convene key stakeholders to make 
recommendations on an integrated national strategy and priorities for 
health care performance measurement in all applicable settings. NQF 
will develop a framework for measure prioritization that will take into 
account the cost and prevalence of the conditions and the likelihood 
and ease of measurement to improve the quality, value and transparency 
of the performance of the health care system. This framework will 
identify those areas where no measures currently exist and will assist 
key stakeholders with the prioritization of those areas in which 
measure development may be required. NQF is currently developing a 
request for proposal to select a subcontractor, and under the guidance 
of NQF, will develop the framework and other documents that will assist 
with identifying critical measurement gap areas as well as prioritize 
those areas through endorsement of measures, reworking existing 
measures and/or measure development. This prioritization framework will 
help guide the future work of this contract and measurement priorities.
Task 7: Implementation of a Consensus Process for Endorsement of Health 
Care Quality Measures
    NQF is a voluntary consensus standards-setting organization and has 
an established multi-stakeholder consensus development process to 
endorse measures appropriate for public reporting and quality 
improvement. The process involves seven steps specifically designed to 
develop consensus among diverse stakeholders: Formation of a steering 
committee, calls for measures, measure evaluation, public comment, 
member voting, review by the consensus standards approval committee and 
board of directors, and appeals. This process has been streamlined to 
better meet the needs of the health care industry. Using this process, 
NQF has endorsed more than 400 quality measures for a variety of health 
care settings. As part of this contract with DHHS, NQF will endorse 
measures and measure sets. These measures will focus on specific 
conditions and settings as well as across episodes of care.
Task 8: Maintenance of Consensus Endorsed Measures
    As an endorsing body, NQF is responsible for maintaining 
endorsement of the consensus standards. Due to evolving research and 
implementation issues, measure maintenance is required by NQF every 
three years. This established process along with annual updates of the 
measure specifications ensures the relevancy of the endorsed measures 
to current health care practice. The ability to critically examine the 
measures on an ongoing basis with built-in requirements for regular 
measure maintenance provides a critical avenue to ensure that the best 
measures are available for public reporting health care performance and 
quality improvement.
Task 9: Promotion of the Electronic Health Records (EHRs)
    EHRs have significant potential to improve the quality, 
coordination, and efficiency of patient care. In the context of 
performance measurement and improvement, they also have a critical role 
to play in collecting chart level clinical patient data, which may be 
reliably used in performance evaluation. The objective of this task is 
for performance measures to have turnkey measurement specifications 
that allow for ready incorporation directly into EHRs; and for EHRs to 
capture the necessary data and possess the necessary functionality to 
calculate and report the performance information and to provide the 
associated clinical decision-support to practitioners to improve 
performance. To achieve these goals, there needs to be ongoing 
communication and collaboration between the performance measurement 
community and the health information technology community. NQF is 
planning to convene these groups to streamline the performance 
measurement enterprise and to promote the use of EHRs to achieve the 
quality improvement goals of DHHS.
Task 10: Annual Report to Congress and the Secretary of the U.S. 
Department of Health and Human Services
    This report will provide an update as to the progress of the tasks 
associated with the contract. NQF will use a structured system for data 
gathering and reporting, and on a monthly basis, will gather 
information for inclusion in the final report. The annual report will 
be available on the NQF Web site for public viewing after copies are 
submitted to the Secretary and to Congress.
Task 11: Development of a Public Web Site for Project Documents
    NQF will provide electronic access on a public website to all of 
the project's final and revised reports, standard operating procedures 
for consensus-building and maintenance procedures, and working 
documents deemed necessary as part of their consensus-building 
processes for any and all tasks issued under this contract. Planning is 
underway for Web site layout and the Web site will ``go live'' in June 
2009.
Task 12: Focused Measure Development, Harmonization, and Endorsement 
Efforts To Fill Critical Gaps in Performance
    NQF is prepared to address measurement gaps identified in Task 6 of 
this contract in a timely, efficient, and effective manner. NQF will 
respond to up to ten requests annually to fill critical gap areas 
through measure endorsement, measure harmonization, measure 
restructuring, and measure development. NQF will subcontract with 
established measure developers to develop new measures, including 
composite measures and/or re-working

[[Page 46603]]

existing measures to fill critical gaps in measures of health care 
performance.
    National Quality Forum, 601 Thirteenth Street, NW., Suite 500 
North, Washington, DC 20005, Fax 202-783-3434, http://www.qualityforum.org.

III. Secretarial Comments on the Annual Report to Congress

    The Secretary is pleased with the scope and vision of NQF's March 
2009 annual report. The contract with this consensus-based entity, NQF, 
provides a unique opportunity to further enhance HHS' efforts to foster 
a collaborative, multi-stakeholder approach to increase the 
availability of national voluntary consensus standards for quality and 
efficiency measures to ensure broad transparency in achieving value in 
health care delivery. An internal multidisciplinary cross-component HHS 
team is working collaboratively with NQF to ensure a clear multi-year 
vision to ensure the most efficient and effective utilization of the 
HHS contract. HHS looks forward to the ongoing opportunity to 
collaborate with the broader health care community as part of this NQF 
contract to ensure a consensus-based national strategy and priority 
setting process for health care measurement focusing on high-quality, 
patient-centered, efficient health care delivery.

IV. Future Steps

    The consensus based contract with NQF is a four year contract. 
During the first year of the contract, NQF shall complete deliverables 
for each task. HHS will task NQF with single year and multi-year 
projects.

Formulation of National Strategy and Priorities for Health Care 
Performance Measurement

    During the first year of the HHS contract, NQF will create a 
framework for measurement prioritization by conducting an environmental 
scan of at a minimum, the 20 patient conditions that account for over 
95% of costs to the Medicare program. NQF is establishing a steering 
committee to oversee the prioritization process.

Maintenance of Consensus Endorsed Measures

    During the first year of the HHS contract, NQF is maintaining 
endorsed measures relevant to HHS-wide programs and will be maintaining 
consensus-based endorsed measures as developed under the priority 
process.

Promotion of Electronic Health Records

    During the first year of the HHS contract, NQF is supporting the 
promotion of electronic health records and quality measurement 
incorporation as part of HHS-wide efforts.

Focused Measure Development, Harmonization, and Endorsement Efforts to 
Fill Critical Gaps in Performance Measurement

    During the first year of the HHS contract NQF is supporting a 
variety of performance measurement efforts including, but not limited 
to, the areas of efficiency, harmonization, outcomes, patient safety, 
care coordination, ICD-10, palliative care, and nursing home quality 
metrics.
    The public is encouraged to give input through the NQF process and 
will be able to track the progress on work related to this contract on 
the NQF Web site located at: http://www.qualityforum.org/projects/ongoing/hhs/.

V. Collection of Information Requirements

    This document does not impose information collection and 
recordkeeping requirements. Consequently, it need not be reviewed by 
the Office of Management and Budget under the authority of the 
Paperwork Reduction Act of 1995 (44 U.S.C. 35).

    Dated: September 3, 2009.
Kathleen Sebelius,
Secretary, Department of Health and Human Services.
[FR Doc. E9-21783 Filed 9-4-09; 4:15 pm]
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