[Federal Register Volume 83, Number 143 (Wednesday, July 25, 2018)]
[Notices]
[Pages 35318-35420]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2018-15763]



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Vol. 83

Wednesday,

No. 143

July 25, 2018

Part II





Department of Health and Human Services





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Secretarial Review and Publication of the National Quality Forum 2017 
Annual Report to Congress and the Secretary of the Department of Health 
and Human Services Submitted by the Consensus-Based Entity Regarding 
Performance Measurement; Notice

Federal Register / Vol. 83 , No. 143 / Wednesday, July 25, 2018 / 
Notices

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

[CMS-3348-N]


Secretarial Review and Publication of the National Quality Forum 
2017 Annual Report to Congress and the Secretary of the Department of 
Health and Human Services Submitted by the 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 Secretary of the Department of 
Health and Human Services' (the Secretary) receipt and review of the 
National Quality Forum 2017 Annual Report to Congress and the Secretary 
submitted by the consensus-based entity under contract with the 
Secretary in accordance with the Social Security Act. The Secretary has 
reviewed and is publishing the report in the Federal Register together 
with the Secretary's comments on the report not later than 6 months 
after receiving the report in accordance with the Act.

FOR FURTHER INFORMATION CONTACT: Sophia Chan, (410) 786-5050.

SUPPLEMENTARY INFORMATION: 

I. Background

    The United States Department of Health and Human Services (HHS) has 
long recognized that a high functioning health care system that 
provides higher quality care requires accurate, valid, and reliable 
measurement of quality and efficiency. The Medicare Improvements for 
Patients and Providers Act of 2008 (MIPPA) (Pub. L. 110-275) added 
section 1890 of the Social Security Act (the Act), which requires the 
Secretary of the Department of Health and Human Services (the 
Secretary) to contract with the consensus-based entity (CBE) to perform 
multiple duties designed to help improve performance measurement. 
Section 3014 of the Patient Protection and Affordable Care Act (the 
Affordable Care Act) (Pub. L. 111-148) expanded the duties of the CBE 
to help in the identification of gaps in available measures and to 
improve the selection of measures used in health care programs.
    HHS awarded a competitive contract to the National Quality Forum 
(NQF) in January 2009 to fulfill the requirements of section 1890 of 
the Act. A second, multi-year contract was awarded to NQF after an open 
competition in 2012. A third, multi-year contract was awarded again to 
NQF after an open competition in 2017. Section 1890(b) of the Act 
requires the following:
    Priority Setting Process: Formulation of a National Strategy and 
Priorities for Health Care Performance Measurement. The CBE must 
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. In 
doing so, the CBE is to give priority to measures that: (1) Address the 
health care provided to patients with prevalent, high-cost chronic 
diseases; (2) have the greatest potential for improving quality, 
efficiency, and patient-centered health care; and (3) may be 
implemented rapidly due to existing evidence, standards of care, or 
other reasons. Additionally, the CBE must take into account measures 
that: (1) May assist consumers and patients in making informed health 
care decisions; (2) address health disparities across groups and areas; 
and (3) address the continuum of care across multiple providers, 
practitioners and settings.
    Endorsement of Measures: The CBE must provide for the endorsement 
of standardized health care performance measures. This process must 
consider whether measures are evidence-based, reliable, valid, 
verifiable, relevant to enhanced health outcomes, actionable at the 
caregiver level, feasible to collect and report, responsive to 
variations in patient characteristics such as health status, language 
capabilities, race or ethnicity, and income level, and are consistent 
across types of health care providers, including hospitals and 
physicians.
    Maintenance of CBE Endorsed Measures: The CBE is required to 
establish and implement a process to ensure that endorsed measures are 
updated (or retired if obsolete) as new evidence is developed.
    Review and Endorsement of an Episode Grouper Under the Physician 
Feedback Program: The CBE must provide for the review and, as 
appropriate, the endorsement of the episode grouper developed by the 
Secretary on an expedited basis.
    Convening Multi-Stakeholder Groups: The CBE must convene multi-
stakeholder groups to provide input on: (1) The selection of certain 
categories of quality and efficiency measures, from among such measures 
that have been endorsed by the entity; (2) such measures that have not 
been considered for endorsement by such entity but are used or proposed 
to be used by the Secretary for the collection or reporting of quality 
and efficiency measures; and (3) national priorities for improvement in 
population health and in the delivery of health care services for 
consideration under the national strategy. The CBE provides input on 
measures for use in certain specific Medicare programs, for use in 
programs that report performance information to the public, and for use 
in health care programs that are not included under the Act. The multi-
stakeholder groups provide input on quality and efficiency measures for 
various federal health care quality reporting and quality improvement 
programs including those that address certain Medicare services 
provided through hospices, hospital inpatient and outpatient 
facilities, physician offices, cancer hospitals, end stage renal 
disease (ESRD) facilities, inpatient rehabilitation facilities, long-
term care hospitals, psychiatric hospitals, and home health care 
programs.
    Transmission of Multi-Stakeholder Input: Not later than February 1 
of each year, the CBE must transmit to the Secretary the input of 
multi-stakeholder groups.
    Annual Report to Congress and the Secretary: Not later than March 1 
of each year, the CBE is required to submit to Congress and the 
Secretary an annual report. The report must describe:
    <bullet> The implementation of quality and efficiency measurement 
initiatives and the coordination of such initiatives with quality and 
efficiency initiatives implemented by other payers;
    <bullet> Recommendations on an integrated national strategy and 
priorities for health care performance measurement;
    <bullet> Performance of the CBE's duties required under its 
contract with the Secretary;
    <bullet> Gaps in endorsed quality and efficiency measures, 
including measures that are within priority areas identified by the 
Secretary under the national strategy established under section 399HH 
of the Public Health Service Act (National Quality Strategy), and where 
quality and efficiency measures are unavailable or inadequate to 
identify or address such gaps;
    <bullet> Areas in which evidence is insufficient to support 
endorsement of quality and efficiency measures in priority areas 
identified by the Secretary under the National Quality Strategy, and 
where targeted research may address such gaps; and
    <bullet> The convening of multi-stakeholder groups to provide input 
on: (1) The selection of quality and efficiency measures from among 
such measures that have been endorsed by the CBE and such measures that 
have not been considered for endorsement by the CBE but are used or 
proposed to be used by the Secretary for the collection or

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reporting of quality and efficiency measures; and (2) national 
priorities for improvement in population health and the delivery of 
health care services for consideration under the National Quality 
Strategy.
    The statutory requirements for the CBE to annually report to 
Congress and the Secretary of HHS also specify that the Secretary must 
review and publish the CBE's annual report in the Federal Register, 
together with any comments of the Secretary on the report, not later 
than 6 months after receiving it.
    This Federal Register notice complies with the statutory 
requirement for Secretarial review and publication of the CBE's annual 
report. NQF submitted a report on its 2017 activities to the Secretary 
on March 1, 2018. Comments from the Secretary on the report are 
presented in section II of this notice, and the National Quality Forum 
2017 Annual Report to Congress and the Secretary of the Department of 
Health and Human Services is provided, as submitted to HHS, in the 
addendum to this Federal Register notice in section III.

II. Secretarial Comments on the National Quality Forum 2017 Annual 
Report to Congress and the Secretary of the Department of Health and 
Human Services

    Once again, we thank NQF and the many stakeholders who participate 
in NQF projects for helping to advance the science and utility of 
health care quality measurement. As part of their annual recurring work 
to maintain a strong portfolio of endorsed measures for use across 
varied settings of care and health conditions, NQF reports that in 2017 
it updated its measure portfolio by reviewing and endorsing or re-
endorsing 120 measures and removing 109 measures. Endorsed measures are 
developed and implemented with input from numerous stakeholders. These 
measures undergo rigorous testing to ensure they are evidence-based, 
reliable, and valid. Continuous refinement of the measures portfolio 
through the measures maintenance process ensures that quality measures 
remain aligned with current field practices and health care goals. HHS, 
with the help of our partners, is committed to implementing measures 
that provide value to payers and actionable information that can be 
used to improve the health of patients.
    NQF also undertook and continued a number of targeted projects 
dealing with difficult quality measurement issues. In particular, NQF 
has worked to help HHS address the unique challenges faced by rural 
communities. Nearly one in five Americans reside in rural 
communities.\1\ HHS recognizes the unique challenges facing rural 
America, and with the support of partners like NQF, we are leveraging 
quality measurement to improve access and quality for healthcare 
providers serving rural patients. NQF recently completed several 
projects that focused on rural health, including Performance 
Measurement for Rural Low-Volume Providers \2\ and Creating a Framework 
to Support Measure Development for Telehealth.\3\ Our reforms in the 
area of rural health are part of our overall strategy to update our 
programs and improve access to high quality services.
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    \1\ U.S. Census Bureau, 2010 Census, Table GCTPH1.
    \2\ https://www.qualityforum.org/Publications/2015/09/Rural_Health_Final_Report.aspx.
    \3\ http://www.qualityforum.org/Publications/2017/08/Creating_a_Framework_to_Support_Measure_Development_for_Telehealth.aspx.
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    In 2017, recognizing the need to strengthen representation of rural 
stakeholders in the pre-rulemaking process, HHS tasked NQF to establish 
a Measures Application Partnership (MAP) Rural Health Workgroup. The 
membership of the MAP Rural Health Workgroup, comprised of 18 
organizational members, seven subject matter experts, and three federal 
liaisons, which reflects the diversity of rural providers and residents 
and allows for input from those most affected and most knowledgeable 
about rural measurement challenges and potential solutions. The MAP 
Rural Health Workgroup represents a continuation of HHS' effort to 
address rural health. With valuable input from our partners and 
stakeholders, HHS can continue to improve health care in rural America.
    The MAP Rural Health Workgroup has focused on identifying a core 
set of the best available, ``rural-relevant'' measures to address the 
needs of the rural population. The MAP Rural Health Workgroup is also 
working to identify measurement gaps with respect to rural communities 
and provide recommendations regarding alignment and coordination of 
measurement efforts across both public and private programs, care 
settings, specialties, and sectors (both public and private). 
Additionally, the MAP Rural Health Workgroup provides guidance for the 
MAP to ensure that measures under consideration address rural provider 
and resident needs and challenges. The MAP Rural Health Workgroup's 
recommendations are also helping to address specific barriers to 
quality reporting faced by rural clinicians. Furthermore, the MAP Rural 
Health Workgroup has provided a space for rural clinicians to broadly 
share their valuable input. Rural physicians contribute unique and 
valuable perspectives critical to addressing national challenges, such 
as the opioid epidemic. However, rural physicians are often isolated 
from national discussions on relevant measures that could identify 
areas of need and gauge prevalence. Highlighting the valuable input 
from rural clinicians opens collaboration opportunities between rural 
providers and providers in other settings as HHS works to integrate new 
measures concerning the prevention and treatment of opioid and 
substance use disorders.
    Addressing the needs of rural health communities is just one of 
many areas in which NQF partners with HHS in enhancing and protecting 
the health and well-being of all Americans. HHS greatly appreciates the 
ability to collaborate with diverse stakeholders and partners to help 
develop the strongest possible approaches to quality measurement as a 
key component to health care delivery system reform.

III. Collection of Information Requirements

    This document does not impose information collection requirements, 
that is, reporting, recordkeeping, or third-party disclosure 
requirements. Consequently, there is no need for review by the Office 
of Management and Budget under the authority of the Paperwork Reduction 
Act of 1995 (44 U.S.C. 3501 et seq.).

IV. Addendum

    In this Addendum, we are publishing the NQF Report on 2017 
Activities to Congress and the Secretary of the Department of Health 
and Human Services, as submitted to HHS.

    Dated: June 21, 2018.
Alex M. Azar II,
Secretary, Department of Health and Human Services.
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[FR Doc. 2018-15763 Filed 7-24-18; 8:45 am]
BILLING CODE 4120-01-C