46594 Federal Register / Vol. 74, No. 174 / Thursday, September 10, 2009 / Notices 

FOR FURTHER INFORMATION CONTACT: Ms. 

Andrea Krull, Public Health Advisor, 

National Vaccine Program Office, 

Department of Health and Human 

Services, Room 715H Hubert H. 

Humphrey Building, 200 Independence 

Avenue, SW., Washington, DC 20201. 

Phone: (202) 690–5566; Fax: (202) 260– 

1165: e-mail; nvpo@hhs.gov. 

Dated: September 3, 2009. 

Bruce Gellin, 

Deputy Assistant Secretary for Health, 

Director, National Vaccine Program Office. 

[FR Doc. E9–21750 Filed 9–9–09; 8:45 am] 

BILLING CODE 4150–44–P 

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. 

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, patientcentered, 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 consensusbased entity. The statute mandates the 

submission of an annual report to both 

Congress and the Secretary of Health 

and Human Services by the consensusbased 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-forperformance 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: 

• 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. 

• Provide for the endorsement of 

standardized health care performance 

measures. 

• Establish and implement a process 

to ensure that measures endorsed are 

updated (or retired if obsolete) as new 

evidence is developed. 

• Promote the development and use 

of electronic health records that contain 

the functionality for automated 

collection, aggregation, and 

transmission of performance 

measurement information. 

• 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: 

• Recent accomplishments that 

provide a foundation for work under 

this contract, and 

• Strategic direction and key 

challenges that lie ahead. 

Foundation for Work: Background and 

Recent Accomplishments 

NQF is a not-for-profit, multistakeholder membership organization 

whose mission 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 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: 

• 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. 

• Endorsing performance measures. 

NQF’s consensus development process 

has resulted in more than 400 endorsed 

measures. 

• 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: 

• Engage patients and families in 

managing their health and making 

decisions about their care. 

• Improve the health of the 

population. 

• Improve the safety and reliability of 

America’s health care system. 

• Ensure patients receive wellcoordinated care within and across all 

health care organizations, settings, and 

levels of care. 

• Guarantee appropriate and 

compassionate care for patients with 

life-limiting illnesses. 

• 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®

measures facilitates making apples-toapples 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: 

• Perinatal Care; 

• Home Health Care; 

• Ambulatory Care; 

• Emergency Care; 

• Health Information Technology; 

• Hospital Care; 

• Immunization; 

• 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 twodimensional 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 PatientFocused 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. 

• 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. 

• The prevention provisions of ARRA 

call for strategies to reduce health careassociated 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. 

• 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 


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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 ReederThompson, 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 highperforming, 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 


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health care-associated infections (HAI) 

and serious adverse events. Health careassociated 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-inclass. 

Ensure Patients Receive WellCoordinated 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 lifelimiting 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 


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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)TM. 

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 consensusbuilding and maintenance procedures, 

and working documents deemed 

necessary as part of their consensusbuilding 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 


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Federal Register / Vol. 74, No. 174 / Thursday, September 10, 2009 / Notices 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] 

BILLING CODE P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Administration for Children and 

Families 

Submission for OMB Review; 

Comment Request 

Title: Head Start Program 

Administrative Practice and Procedure; 

Appeal Procedures, 45 CFR Part 1303. 

OMB No.: 0980–0242. 

Description: Section 646 of the Head 

Start Act requires the Secretary of 

Health and Human Services to prescribe 

a timeline for conducting administrative 

hearings when adverse actions are taken 

or proposed against Head Start and 

Early Head Start grantees and delegate 

agencies. The Office of Head Start is 

proposing to renew, without changes, 

this rule, which implements these 

requirements and which prescribes 

when a grantee must submit certain 

information and what that information 

shall include. 

Respondents: Head Start and Early 

Head Start grantees and Delegate 

Agencies. 

ANNUAL BURDEN ESTIMATES

Instrument Number of 

respondents 

Number of 

responses per 

respondent 

Average 

burden hours 

per response 

Total burden 

hours 

Rule .................................................................................................................. 20 1 26 520 

Estimated Total Annual Burden 

Hours: 520. 

Additional Information: Copies of the 

proposed collection may be obtained by 

writing to the Administration for 

Children and Families, Office of 

Administration, Office of Information 

Services, 370 L’Enfant Promenade, SW., 

Washington, DC 20447, Attn: ACF 

Reports Clearance Officer. All requests 

should be identified by the title of the 

information collection. E-mail address: 

infocollection@acf.hhs.gov. 

OMB Comment: OMB is required to 

make a decision concerning the 

collection of information between 30 

and 60 days after publication of this 

document in the Federal Register. 

Therefore, a comment is best assured of 

having its full effect if OMB receives it 

within 30 days of publication. Written 

comments and recommendations for the 

proposed information collection should 

be sent directly to the following: Office 

of Management and Budget, Paperwork 

Reduction Project, Fax: 202–395–7245, 

Attn: Desk Officer for the 

Administration for Children and 

Families. 


erowe on DSK5CLS3C1PROD with NOTICES