[Federal Register Volume 75, Number 204 (Friday, October 22, 2010)]
[Notices]
[Pages 65340-65349]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2010-26795]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES


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: Kate Goodrich (202) 690-7213.

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, a competitive contract was awarded by HHS to the 
National Quality Forum (NQF) for a four-year period. The contract 
specified that NQF should conduct its business in an open and 
transparent manner, provide the opportunity for public comment and 
ensure that 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

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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, 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 website 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. 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.
    The first annual report covered the performance period of January 
14, 2009 to February 28, 2009 or the first six weeks post contract 
award. Given the short timeframe between award and the statutory 
requirement for the submission of the first annual report, the first 
annual report provided a brief summary of future plans. In March 2009, 
NQF submitted the first annual report to Congress and the Secretary of 
HHS. The Secretary published a notice in the Federal Register in 
compliance with the statutory mandate for review and publication of the 
annual report on September 10, 2009 (74 FR 46594).
    In March 2010, NQF submitted to Congress and Secretary of HHS the 
second annual report. This notice complies with the statutorily 
required Secretarial review and publication of the second annual report 
covering the period of performance of March 1, 2009 through February 
28, 2010.

II. March 2010--NQF Report to Congress and HHS Secretary

    Submitted in March 2010, the second annual report to Congress and 
the Secretary spans the period of March 1, 2009 through February 28, 
2010.
    A copy of NQF's submission of the March 2010 annual report to 
Congress and the Secretary of HHS can be found at: http://www.qualityforum.org/projects/ongoing/hhs/.
    The 2010 NQF annual report is reproduced in section III of this 
notice.

III. NQF March 2010 Annual Report

Strengthening the National Quality Infrastructure National Quality 
Forum Accomplishments Under Contract <greek-i>HHSM-500-209-00010C

    Report to the Congress and the Secretary of the U.S. Department of 
Health and Human Services, Covering the period of March 1, 2009, to 
February 28, 2010, Pursuant to PL 110-275 and Contract <greek-i>HHSM-
500-209-00010C

Table of Contents

A Message From the Leadership of the National Quality Forum 
Executive Summary
About the Contract
Work Performed by the National Quality Forum Under the DHHS Contract 
in 2009
2010 and Beyond: A Look Ahead
Appendices and Notes
Appendix A: About NQF
Appendix B: NQF Board of Directors
Appendix C: NQF Key Staff
Appendix D: National Priorities Partnership
    Notes

    The mission of the National Quality Forum is to improve the quality 
of American healthcare 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.

A Message From the Leadership of the National Quality Forum

    Ten years ago, the Institute of Medicine (IOM) exposed the U.S. 
healthcare system's numerous quality and patient safety deficiencies 
with the publication of its landmark report, To Err is Human.\1\ In the 
decade since, numerous local, regional, and national quality 
improvement initiatives, including but not limited to programs 
supported by the federal and state governments, have sought to correct 
these deficiencies. Many of these activities have borne fruit. Some can 
definitively be credited with saving American lives.
    Despite these successes, and despite the dedicated effort of 
millions of well-trained, committed, and compassionate healthcare 
workers, the quality of healthcare in the United States still is not 
nearly as good as it could or should be. Thousands of Americans die 
every year, and millions more are injured, as a result of medical 
error. Processes of care vary widely by region, state, and provider, 
with no apparent benefit to patients. Healthcare in the United States 
is plagued by inequities based on race, ethnicity, gender, and other 
factors.

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Costs--including costs to taxpayers--have skyrocketed. Millions of 
Americans are denied access to care because they lack sufficient 
insurance.
    As the decade progressed, it became clear that the nation's 
numerous quality initiatives, successful though many may have been, 
were no substitute for a coordinated national strategy to 
systematically improve the quality of healthcare in the United States. 
To help formulate such a strategy, Congress in 2008 passed the Medicare 
Improvements for Patients and Providers Act (Pub. L. 110-275).\2\ One 
goal of the legislation is to establish a portfolio of quality and 
efficiency measures that will allow the federal government to see more 
clearly how and whether public healthcare spending is achieving the 
best results for Americans. On January 14, 2009, NQF was awarded a 
contract that addresses the Act's Section 183, which calls for the 
Department of Health and Human Services (DHHS) ``to contract with a 
consensus-based entity, such as the National Quality Forum.'' This 
report summarizes the work performed under this contract between March 
1, 2009, and February 28, 2010, the first full year that the DHHS 
contract has been in place.
    As we review the work performed over the past year, it becomes 
apparent that 2009 was a year of building infrastructure to support 
healthcare quality. Much like physical infrastructure, the nation's 
healthcare quality infrastructure must be constructed with precise 
attention to detail, and then maintained so that it meets the expanding 
needs of those it serves. Priorities and goals must be identified to 
focus improvement efforts on areas that will yield the greatest gains 
in terms of improved health and healthcare; and performance measures 
must be developed, endorsed, and implemented to gauge delivery system 
progress and reveal opportunities for improvement.
    Many of the activities NQF has performed under the DHHS contract 
are in midstream and extend beyond a single year's worth of work. 
Nevertheless, we have completed significant work in several areas, 
including:
    <bullet> The development of a prioritized set of conditions for 
quality improvement;
    <bullet> The endorsement of performance measures in critical gap 
areas; and
    <bullet> The establishment of common protocols and standardized 
formats for e-measure specification and the creation of an electronic 
measure authoring environment to enable retooling of performance 
measures for the assessment of ``meaningful use'' of health information 
technology (HIT).
    We are grateful to Congress and DHHS for supporting NQF's work in 
nurturing the quality enterprise in the United States; to the more than 
400 institutional members of NQF who have sustained the organization 
and, in doing so, have helped build the healthcare quality improvement 
movement; and to NQF's expert panel volunteers and staff, whose 
tireless efforts on behalf of American patients contribute to a 
healthcare system that is becoming, as the IOM envisioned, safe, 
timely, effective, efficient, equitable, and patient centered.
    During the last year, we built a stronger foundation for healthcare 
performance improvement in the United States. We are confident that in 
2010 and beyond, Americans will reap the benefits of our healthcare 
quality infrastructure.

1. Executive Summary

    The National Quality Forum (NQF) was created in 1999 to develop and 
implement a national strategy for healthcare quality improvement. It 
has grown into an influential consensus-based organization in 
healthcare in the United States, supported by more than 400 
organizational members and boasting a unique structure that enables 
private and public sector stakeholders to collaborate on cross-cutting 
solutions to drive continuous performance improvement. NQF's core work 
includes the establishment of national priorities and the endorsement 
of performance measures. NQF follows a formal Consensus Development 
Process recognized under the National Technology Transfer and 
Advancement Act of 1995 (Pub. L. 104-113), which grants its endorsed 
measures and best practices special legal standing as national 
voluntary consensus standards.
    Section 183 of the Medicare Improvements for Patients and Providers 
Act (Pub. L. 110-275) of 2008 calls for the Department of Health and 
Human Services (DHHS) ``to contract with a consensus-based entity, such 
as the National Quality Forum'' (NQF) for the purpose of pursuing 
certain activities relating to healthcare performance measurement. On 
January 14, 2009, the National Quality Forum was awarded a contract 
under this Section. The contract provided up to $10 million for the 
first year after award with the option for three $10 million annual 
renewals. Among other assignments, the contract called for NQF to:
    <bullet> Develop a prioritized list of conditions that impose heavy 
health burden on beneficiaries and account for significant costs;
    <bullet> Identify and endorse measures that can be used by various 
stakeholders to assess and improve the care provided to beneficiaries 
with these conditions, and the performance of providers in various 
healthcare settings; and
    <bullet> Promote the use of electronic health records (EHRs) for 
performance measurement, reporting, and improvement.
    This report summarizes the work performed under this contract 
between March 1, 2009, and February 28, 2010, the first full year that 
the DHHS contract has been in place.
    Many of the activities NQF has performed under the DHHS contract 
are in midstream and extend beyond a single year's worth of work. Under 
the DHHS contract, NQF has achieved significant accomplishments in the 
following areas:
    <bullet> Developed a framework, composed of the 20 priority 
conditions for Medicare and the six cross-cutting priority areas 
identified by the NQF-convened National Priorities Partnership, for 
focusing performance measurement, public reporting, and improvement 
efforts;
    <bullet> Conducted an environmental scan of existing performance 
measures and measures under development, and began constructing a 
prioritized agenda for measure development and endorsement;
    <bullet> Initiated endorsement projects to expand the portfolio of 
NQF-endorsed[supreg] measures in key gap areas: Patient outcomes, 
efficiency, patient safety, and nursing home care;
    <bullet> Enhanced processes for ongoing ``measure maintenance'' to 
ensure that the more than 550 measures that NQF already has endorsed 
are continuously updated to reflect changes in the evidence base as it 
evolves and undergo comprehensive assessment on a three-year cycle to 
maintain ``best in class'' standing;
    <bullet> Contracted with an applied research firm to conduct an 
independent evaluation of its Consensus Development Process;
    <bullet> Began work on a two-year plan for the evolution of NQF's 
portfolio of endorsed patient safety measures, ``safe practices,'' and 
serious reportable events;
    <bullet> Undertook an environmental scan to review the state of 
reporting with respect to patient safety events and serious reportable 
events at the federal and state level;

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    <bullet> Completed an evaluation of the types of data that must be 
captured in electronic health records (EHRs) to support measurement and 
improvement on the more than 550 NQF-endorsed performance measures;
    <bullet> Developed a standardized format (i.e., the Health Quality 
Measure Format) for representing a health quality measure in a machine-
readable electronic format, which has now been approved by HL7 for use 
in EHRs; and
    <bullet> Produced an enhanced Web site, featuring an online 
performance measure submission form, an improved online platform for 
public comment, and an online directory of NQF-endorsed consensus 
standards.
    Much like physical infrastructure, the nation's Healthcare quality 
infrastructure must be constructed with precise attention to detail, 
and then maintained so that it meets the expanding needs of those it 
serves. In 2009, under the DHHS contract, NQF took great strides in 
building and supporting that infrastructure. In 2010 and beyond, the 
United States will reap significant benefits from investments in this 
quality infrastructure, which is critical to support expanded public 
reporting and payment reform and foster continuous quality improvement 
in American healthcare.

2. About the Contract

    The Medicare Improvements for Patients and Providers Act of 2008 
(Pub. L. 110-275) is a wide-ranging law that addresses many aspects of 
Medicare and Medicaid, including the addition of new benefits for 
Medicare beneficiaries. Section 183 of the Act, among other things, 
directs the Secretary of DHHS to contract with a consensus-based entity 
for certain activities relating to healthcare performance measurement.
    On January 14, 2009, NQF was awarded a contract, HHSM-500-209-
00010C, under Section 183 of the Medicare Improvements for Patients and 
Providers Act. The DHHS contract is administered by the Office of the 
Assistant Secretary for Planning and Evaluation (ASPE), which provides 
strategic leadership and technical insight for the contract, and by the 
Centers for Medicare & Medicaid Services (CMS), which provides 
technical input and operational support. The contract provided up to 
$10 million for the first year after award, with the option for three 
$10 million annual renewals through 2012. It called for NQF to:
    <bullet> Develop a prioritized list of conditions that impose heavy 
health burden on beneficiaries and account for significant costs;
    <bullet> Identify and endorse measures that can be used by various 
stakeholders to assess and improve the care provided to beneficiaries 
with these conditions, and the performance of providers in various 
healthcare settings;
    <bullet> Identify programs to track and disseminate measures;
    <bullet> Ensure performance measures are regularly and 
appropriately updated and remain relevant for public reporting and 
improvement;
    <bullet> Promote the use of EHRs for performance measurement, 
reporting, and improvement; and
    <bullet> Report annually to Congress on the status of the project 
and progress to date.
    While the work conducted under the contract is intended 
specifically to benefit all those served by DHHS programs, it will have 
the salutary additional benefit of improving care for all Americans. 
The work being conducted under this contract directly relates 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 has endorsed more than 
500 performance measures and best practices under its formal Consensus 
Development Process, granting those measures and practices special 
legal standing as voluntary consensus standards.
    <bullet> Facilitating the development of EHRs 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.
    Under the contract, DHHS asked that performance 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.''
    The contract is divided into 12 tasks. Six of the tasks are 
procedural--involving an opening meeting, the development of a work 
plan, the development and implementation of a quality assurance 
Internal Evaluation Plan, weekly conference calls, monthly progress 
reports, and the creation of this annual report. The remaining six call 
for specific deliverables and are the focus of this report.
    Task 6 is the formulation of a national strategy and priorities for 
healthcare performance measurement. Task 7 is the implementation of a 
consensus process for the endorsement of healthcare quality measures. 
Task 7 includes an evaluation of NQF's Consensus Development Process 
and the conduct of consensus projects focusing on known measure gap 
areas. Task 8 is the maintenance of previously endorsed NQF measures. 
Task 9 is the promotion of EHRs. Task 11 is the development of a public 
Web site for project documents. Task 12 calls for measure development, 
harmonization, and endorsement efforts to fill critical gaps in 
performance measurement. Task 12 is divided into three subtasks: 
Efficiency, harmonization, and ICD-10.
    Details of work performed under the DHHS contract in each of these 
tasks are found in Section 3 of this report.

3. Work Performed by the National Quality Forum Under the DHHS Contract 
in 2009

    This section describes details of work performed under each task 
according to the DHHS contract in the past year.

National Strategy and Priorities (Task 6)

    A two-dimensional framework--consisting of leading conditions and 
cross-cutting areas--has been developed to focus performance 
measurement and improvement on high-leverage areas having the greatest 
potential to improve health and healthcare. Starting with the Medicare 
20 priority conditions, which collectively account for 95 percent of 
Medicare expenditures (see Exhibit A), an expert panel is working to 
prioritize these conditions based on cost, prevalence, improvability, 
variability, and disparities. The second part of the strategy builds on 
work previously performed by the National Priorities Partnership,\3\ 32 
major national healthcare stakeholder organizations (see Appendix D) 
convened by NQF, which identified six crosscutting priority areas that 
affect many conditions: Patient and family engagement, population 
health, safety, care coordination, palliative and end-of-life care, and 
overuse.\4\ To identify gaps, currently available performance measures 
have been mapped to this framework.
    To further inform the process of setting an agenda for measure

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development and endorsement, NQF is convening experts and gathering 
information to identify specific types of measures needed to support 
Medicare payment and public reporting programs, ``meaningful use'' of 
HIT, and other applications. This work is scheduled for completion in 
the third quarter of 2010.

Exhibit A: Medicare 20 Priority Conditions

    To assist in carrying out its responsibilities, in 2009 NQF issued 
a firm, fixed-price contract for a qualified contractor to perform a 
systematic review and synthesis of evidence relating to 20 high-
priority conditions identified by the Centers for Medicare & Medicaid 
Services. Patients with these conditions account for more than 95 
percent of Medicare's costs. The 20 conditions (not in any order of 
priority) are:
    <bullet> Acute myocardial infarction
    <bullet> Alzheimer's disease and related disorders
    <bullet> Atrial fibrillation
    <bullet> Breast cancer
    <bullet> Cataract
    <bullet> Congestive heart failure
    <bullet> Chronic kidney disease
    <bullet> Colorectal cancer
    <bullet> Chronic obstructive pulmonary disorder
    <bullet> Diabetes
    <bullet> Endometrial cancer
    <bullet> Glaucoma
    <bullet> Hip/pelvic fracture
    <bullet> Ischemic heart disease
    <bullet> Lung cancer
    <bullet> Major depression
    <bullet> Osteoporosis
    <bullet> Prostate cancer
    <bullet> Rheumatoid arthritis and osteoarthritis
    <bullet> Stroke/transient ischemic attack

Consensus Development Process for Measure Endorsement (Task 7)

    The stakeholder-based endorsement of performance measures via a 
formal Consensus Development Process (CDP) has long been NQF's ``stock 
in trade.'' This task involves both a formal evaluation of the 
endorsement process and the conduct of a set of endorsement projects 
focused on known measure gap areas.
    Evaluation of the Consensus Development Process. NQF follows a 
nine-step process (Exhibit B) to evaluate and endorse consensus 
standards, including performance measures, serious reportable events, 
best practices, measurement frameworks, and reporting guidelines. The 
process is designed to ensure that performance measures endorsed by NQF 
satisfy certain criteria (i.e., importance, scientific acceptability, 
usability, and feasibility) and represent the ``best in class.'' The 
process is transparent and provides for extensive input from all 
stakeholders. Over the past 10 years, the steps that form NQF's 
Consensus Development Process and its implementation have evolved to 
ensure that evaluation of Candidate Consensus Standards continues to 
follow best practices in performance measurement and standards setting. 
In 2009, under the DHHS contract, NQF contracted with Mathematica 
Policy Research Inc. to conduct an independent evaluation of the 
Consensus Development Process. This evaluation also includes gathering 
information on similar processes of other standard-setting bodies, 
which is expected to be useful in further refining NQF's endorsement 
process. This report is scheduled for completion in October 2010, with 
the proposed enhancements to the Consensus Development Process 
scheduled to be considered in January 2011.

Exhibit B: NQF Consensus Development Process (Version 1.8)

    1. Call for Intent to Submit Candidate Standards.
    2. Call for Nominations.
    3. Call for Candidate Standards.
    4. Candidate Consensus Standard Review.
    5. Public and Member Comment.
    6. Member Voting.
    7. Consensus Standards Approval Committee Decision.
    8. Board Ratification.
    9. Appeals.
    Endorsement Projects. The current DHHS contract facilitates a 
coordinated, strategic approach to endorsing performance measures.
    As noted above, efforts are underway to develop a comprehensive 
agenda for measure development and endorsement, which will guide future 
endorsement work. During this first year of the DHHS contract, the 
schedule of endorsement projects was determined though a collaborative 
process involving representatives from the various DHHS departments and 
NQF, targeting well-known gap areas. On average, it takes less than one 
year to complete the nine-step Consensus Development Process. 
Endorsement projects fall into two broad categories: Quality and 
efficiency, and patient safety.
    Quality and Efficiency. Many projects in this area focus on 
measures of patient outcomes and efficiency, thus laying the groundwork 
for assessing the ``value'' received from healthcare services. 
Considerable attention also is paid to settings outside the hospital 
and to care transitions.
    <bullet> Patient outcome measures. This three-phase project focuses 
on cross-cutting and condition-specific outcome measures. Specifically, 
outcome measures will be endorsed for patients with Medicare high 
priority conditions, such as: Congestive heart failure, chronic 
obstructive pulmonary disease, arthritis, diabetes, depression, and 
several types of cancers. There is also a phase of work dedicated to 
outcome measures for children. The conditions included in each phase 
are:
    [cir] Phase I: Cardiovascular diseases, including acute myocardial 
infarction, ischemic heart disease, congestive heart failure, atrial 
fibrillation, and stroke/transient ischemic attacks, metabolic 
diseases, including diabetes and chronic kidney disease; and pulmonary 
diseases, including asthma and chronic obstructive pulmonary disease.
    [cir] Phase II: Cancer, including breast, lung, colorectal, and 
endometrial cancers; bone/joint diseases, including hip fracture, 
osteoporosis, and arthritis; and infection, including pneumonia.
    [cir] Phase III: Child health and mental health. In future years, 
measures derived from this phase include a core measure set for the 
Children's Health Insurance Program Reauthorization Act of 2009.
    <bullet> Nursing home measures. This project focuses on the 
endorsement of performance measures for nursing homes. It will include 
an updated set of measures to assess and improve care provided in 
nursing homes.
    Patient Safety. NQF has a sizable portfolio of endorsed serious 
reportable events, patient safety measures, and safe practices that are 
used extensively by DHHS and states in reporting and payment programs, 
and by providers for improvement purposes. On October 6, 2009, NQF 
convened the Patient Safety Advisory Committee to assess current 
initiatives and develop a two-year strategic work plan for the 
evolution of the NQF portfolio. This strategic plan, when completed in 
fall 2010, will guide NQF's safety work in 2011 and 2012. The initial 
set of 2009 projects focuses on known gap areas.
    <bullet> Serious Reportable Events (SREs). NQF has long been a 
pioneer in this area, dating to its 2002 report Serious Reportable 
Events in Healthcare: A Consensus Report, which listed 27 preventable 
events leading to death or serious injury that should be publicly 
reported. (The program was updated in 2006, with a 28th event added.) 
This list formed the core of the Medicare non-payment program for 
healthcare-acquired conditions, as well as many state-based adverse 
event reporting initiatives. This project will consider

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expanding the list of serious reportable events to include events that 
are applicable to additional non-hospital settings, such as nursing 
homes and ambulatory care settings. The project includes convening 
representatives of state-based adverse event-reporting agencies to 
review the current environment of adverse event reporting systems, 
related issues, and unintended consequences, as well as to obtain their 
input on the next generation of events.
    <bullet> Patient safety measures. This project focuses on key 
safety measures such as healthcare-associated infections. As a part of 
this project, currently endorsed infection measures will be updated to 
reflect updated case definitions from the Centers for Disease Control 
and Prevention. Other focus areas for patient safety measures will 
include condition specific measures and reviewing applicability of 
safety measures to a variety of environments of care.
    <bullet> Patient safety public reporting guidelines. Public 
reporting of patient safety performance results can be challenging, 
especially for serious reportable events and low-frequency safety 
events. This project aims to develop a framework and guidelines for 
measuring, evaluating, and publicly reporting patient safety 
information across the spectrum for severity and frequency of events.

Maintenance of Previously Endorsed Measures (Task 8)

    Healthcare performance measures and similar consensus standards are 
useful for improving quality only as long as the standards reflect 
current knowledge and state-of-the art, high-quality care. The 
maintenance of NQF-endorsed measures is of critical importance because 
the science underlying both clinical practice and safe, effective, and 
efficient care delivery evolves over time. Ongoing maintenance 
processes also ensure that measure specifications reflect updates in 
coding systems, such as ICD-10-CM.
    Specifically, the currency of the NQF portfolio refers to four 
factors:
    1. Importance of the Measure Topic. Does the measure reflect 
current clinical science and guidelines? Is there still a gap between 
actual and ideal performance? (Or is the measure ``topped out?'')
    2. Measure Specifications. Do the specifications reflect current 
coding and classification systems? (In addition, as discussed below, 
future maintenance processes will require stewards to submit e-
specifications so measures can be used with electronic health records.)
    3. Harmonization. There are currently dozens of measure developers, 
all of whom follow different conventions and practices when specifying 
measures. Through its endorsement and maintenance processes, NQF works 
with measure stewards to harmonize their measures. Harmonization 
facilitates the use of measures in sets (e.g., a composite measure for 
patients with diabetes that reflects the outcomes and clinical process 
measures for a patient-focused episode) and makes it easier to 
understand and interpret results. Harmonization also lessens the burden 
of implementation.
    4. Best in Class. There is much innovation in the development of 
measures. NQF-endorsed measures are subject to a competitive review 
every three years in which they must demonstrate ``best in class'' when 
compared directly with other candidate measures.
    In 2009, NQF developed a comprehensive schedule for review of 
measures pertaining to the leading conditions and the National 
Priorities Partnership cross-cutting areas. The new measure maintenance 
schedule will provide an annual update of measure specifications. 
Measures will undergo a comprehensive review at least every three 
years, including harmonization and best in class considerations. In 
addition to scheduled maintenance, ad hoc maintenance reviews are 
conducted if there are significant changes in the science base 
requiring immediate attention or concerns are raised about untoward 
consequences of measurement.

Promotion of EHRs (Task 9)

    It is broadly recognized that EHR systems can improve the quality 
of care delivered to patients. Health information technology (HIT)-
enabled content and transactions can make important healthcare 
information more readily available to those who need it when they need 
it. If implemented with careful attention to workflow and content 
needs, EHR systems will appreciably improve the safety, effectiveness, 
and efficiency of American healthcare, leading to widespread and 
sustainable quality improvement. Such systems will support clinical 
decisions; grant patients and clinicians access to health records and 
improve the accuracy of those records; seamlessly integrate clinical 
and payment functions; and facilitate the collection, reporting, and 
analysis of quality data.
    <bullet> The ``eMeasure.'' In 2009, NQF developed and oversaw 
standardization of the Health Quality Measure Format, commonly known as 
the ``eMeasure,'' representing a health quality measure in a machine-
readable electronic format. Through standardization of a measure's 
structure, metadata, definitions, and logic, the eMeasure provides 
quality measure consistency and unambiguous interpretation. The 
eMeasure is a critical component of the workflow to support 
``meaningful use'' of electronic records as described by the American 
Recovery and Reinvestment Act of 2009. The eMeasure was successfully 
balloted by the technical standards development organization HL7 at its 
September 2009 workgroup meeting. The sponsoring workgroup, Structured 
Documents, approved the ballot as a draft standard for trial use on 
November 4, 2009. The measure was successfully tested in the HITSP 
Connectathon in January 2010.
    <bullet> Measure Retooling. In 2009, under the DHHS contract, NQF 
undertook implementation of its previously completed Quality Data Set 
(QDS) \5\ (see Exhibit C) by applying the QDS to measures already 
endorsed by NQF. NQF staff created an authoring environment for the 
retooling effort to manage consistency with the QDS and to make the 
process as efficient as possible. That environment is complete and will 
be used by measure developers to retool high-priority measures 
requested by CMS.
    <bullet> QDS Model and Repository. In the contract's first year, 
some work on standardizing the management of code lists was performed 
in the standards harmonization process in the Healthcare Information 
Technology Standards Panel (HITSP) in summer 2009. The HIT Standards 
Committee has now established a task force on vocabulary, which began 
work in January 2010 to define the governance and infrastructure rules 
for vocabulary management. NQF's participation in that task force 
supports the registry requirements in a stand.

Exhibit C: About the QDS

    The Quality Data Set (QDS), developed by NQF's Health Information 
Technology Expert Panel (HITEP), is a set of data elements or types of 
data elements that can be used as the basis for developing harmonized 
and machine-computable quality measures. It is a classification system 
by which measure developers can offer and refine definitions. Once 
fully developed, the QDS will be a centralized repository of quality 
data requirements (such as concepts, data types, data elements, and 
code lists) and data definitions used by multiple stakeholders to 
develop, specify, and use quality measures. The QDS aims to provide 
direction to

[[Page 65346]]

measure developers, EHR vendors, and other stakeholders on how to 
define quality terminology without ambiguity. Although the QDS was 
developed under an earlier grant from the Agency for Healthcare 
Research and Quality, its implementation is covered under the current 
DHHS contract.ard manner.
    <bullet> Measure Authoring Tool and Guidelines. In 2009, NQF 
identified requirements for a measure authoring tool and created a 
prototype environment for use in the measure retooling effort. An NQF 
tooling/retooling guide is planned that will expand on that effort, and 
a more detailed authoring tool will be available for use to create 
electronic measures in January 2011.
    <bullet> Linking Performance Measurement to Clinical Decision 
Support. NQF convened a Clinical Decision Support Expert Panel, which 
met on November 11-12, 2009. The panel created a clinical decision 
support taxonomy framework and adapted the QDS data requirements to 
support clinical decision support.

The Development of a Public Web Site (Task 11)

    NQF in 2009 undertook an effort to redevelop its own Web site to 
guarantee that its proceedings would be fully transparent to all 
stakeholders. The Web site, http://www.qualityforum.org, is now fully 
operational and features an electronic measure submission form to 
enhance the Consensus Development Process and measure maintenance 
activities. Specifically, funding from the DHHS contract in this task 
was used to:
    <bullet> Produce a new Web site for information about NQF's 
Consensus Development Process and its specific projects, including 
their status and opportunities for public and member input;
    <bullet> Implement additional Web site features; and
    <bullet> Perform ongoing management of web-based content.
    The site was developed and is operated using a content management 
system to support better content organization and maintenance and 
editorial oversight. The implementation included integration with other 
NQF systems and laid a technological foundation that will enable future 
enhancements. Achievements resulting from this work include:
    <bullet> A new structure for project information that clearly 
presents the progress of work through NQF's Consensus Development 
Process and supports and encourages public review and input;
    <bullet> Site personalization for registered users, including a 
dashboard in which users can access information about their 
participation in NQF activities;
    <bullet> An online measure submission form and process that 
improves the electronic collection and dissemination of the information 
needed to evaluate performance measures for potential endorsement;
    <bullet> An improved online voting platform, including the ability 
for users to see the status of their organization's participation; and
    <bullet> An online directory of NQF-endorsed consensus standards.

Measurement Development, Harmonization, and Endorsement (Task 12)

    The DHHS contract provides for measure development and related 
activities to fill gap areas. In 2009, NQF published requests for 
proposals for ``indefinite need, indefinite quantity'' contracts to 
build capacity in case DHHS decides that performance measures are 
needed in any given area. This capacity was not requested by DHHS in 
the first year of the contract. Other specific projects under this task 
included:
    <bullet> Harmonization. To identify gaps in appropriate care at the 
appropriate junctures, work is needed to adopt global, harmonized 
quality measures in all settings. The opportunity to link measurement 
across providers and sites of care will form the foundation for a 
systems-based perspective to healthcare delivery, the reduction or 
elimination of preventable illnesses, and the delivery of high-quality 
care. Thus, NQF is planning to identify the steps needed to achieve 
harmonization, including how to encourage measure developers to achieve 
measure harmonization with measures across sites and providers of care. 
This work is ongoing.
    <bullet> Efficiency and resource use measures. The current 
portfolio of NQF measures contains very limited numbers of performance 
measures to assess efficiency and resource use. In its new phase of 
work, NQF has received 18 measures in mammography, appropriate use of 
CT scans, and cardiac imaging. A second phase of work will focus on 
measures of episode-based resource use.
    <bullet> ICD-10. DHHS utilizes various code sets to classify 
medical care for purposes of payment and performance measurement. The 
International Classification of Diseases (ICD) code set \6\ is used to 
identify diagnoses (diseases, injuries, and impairments) and procedures 
(diagnosing, managing, treating, preventing). DHHS intends to convert 
from the ICD, Ninth Revision (ICD-9) to ICD, Tenth Revision, Clinical 
Modification (ICD-10-CM) by 2013. In this project, NQF is examining the 
implications of additional code set requirements on performance 
measures and developing guidance and a schedule for updating measures 
by the 2013 coding conversion deadline. In 2009, NQF convened an expert 
panel to consider coding issues and how they affect performance 
measurement, including defining and laying out a process for responding 
to ``material changes'' in measures that may result from the coding 
conversion process. This work is ongoing.

4. 2010 and Beyond: A Look Ahead

    The decade since IOM published To Err is Human has seen the 
maturation of the modern-day healthcare quality improvement movement in 
the United States. It is no longer accepted as a matter of faith that 
the United States boasts the ``best healthcare system in the world.'' 
Today, we know that despite the heroic effort of millions of dedicated 
individuals, healthcare quality is deficient in many areas. Further, we 
know that healthcare quality is measurable, and that quality 
deficiencies must be measured--with the results of these measurements 
publicly reported--if we hope to correct them. This recognition, while 
sobering, has led to a national commitment to improve the quality of 
healthcare for all Americans. Following this commitment, the 
recognition has led to the construction of a national infrastructure 
for quality improvement--including the formulation of national 
priorities, the use of agreed-upon performance measures to gauge 
quality, and an EHR system to collect and disseminate performance data.
    As the quality movement has matured, so too has the National 
Quality Forum. When the President's Advisory Commission on Consumer 
Protection and Quality in the Health Care Industry proposed the 
creation of a forum that would convene disparate stakeholders to 
formulate a national strategy for healthcare quality, the idea seemed 
novel. Today, NQF is itself a firmly entrenched stakeholder, advocating 
for healthcare quality improvement while serving no interest other than 
that of the public at large.
    NQF's work today supports key DHHS work outlined in the American 
Recovery and Reinvestment Act of 2009 in three important ways:
    <bullet> Supporting the HIT provisions by ensuring that EHRs have 
the necessary capabilities to foster performance measurement and public 
reporting;

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    <bullet> Focusing performance improvement activities on reducing 
healthcare-associated infections and enhancing chronic disease 
outcomes; and
    <bullet> Identifying key gaps in the evidence base to sustain the 
Recovery Act's comparative effectiveness research goals.
    NQF remains firmly committed to a broad, quality-focused 
transformation of the healthcare system, including supporting goals in 
quality, access, and affordability that may be achieved through 
national health reform legislation.
    The focus of the American quality improvement endeavor has moved 
beyond measures of process to include measures of outcomes that matter 
most to patients. In response to soaring healthcare costs, efforts are 
now underway to develop and endorse efficiency measures that can be 
used to remove waste and unnecessary services from the healthcare 
system. This shift is fraught with challenges as the healthcare 
industry seeks to find and agree upon measures that are important, 
scientifically acceptable, usable, and feasible--and is subject to 
controversy because results of these measures will be used in payment 
and public reporting programs.
    The quality infrastructure we are building today will be important 
for decades to come. It is a fundamental building block for 
transforming the American healthcare system to provide patient-centered 
care that is safe, effective, and affordable.
    The National Quality Forum, Washington, DC, March 1, 2010.

5. Appendices and Notes

Appendix A: About National Quality Forum

    The National Quality Forum is a nonprofit organization that aims 
to improve the quality of healthcare for all Americans through 
fulfillment of its three-part mission:
    <bullet> Setting national priorities and goals for performance 
improvement;
    <bullet> Endorsing national consensus standards for measuring 
and publicly reporting on performance; and
    <bullet> Promoting the attainment of national goals through 
education and outreach programs.
    NQF was created in 1999 at the recommendation of the President's 
Advisory Commission on Consumer Protection and Quality in the Health 
Care Industry.\7\ Today, it is uniquely positioned to serve as a 
national coordinating and standard-setting center for performance 
measures. The NQF Board of Directors includes public- and private-
sector representatives, with a simple majority of its at-large seats 
held by consumers and those who purchase services on their behalf. 
(See Appendix B.) It works collaboratively with multiple quality 
alliances, and has unmatched experience in evaluating and endorsing 
measures of healthcare performance, many of which are in widespread 
use. From its inception, NQF sought to convene disparate 
stakeholders to work toward the common goal of improving healthcare 
quality by advancing performance measurement and public reporting. 
NQF member organizations are organized into eight member councils--
consumers; purchasers; healthcare professionals; health plans; 
provider organizations; public/community health agencies; quality 
measurement, research and quality improvement organizations; and 
suppliers and industry.
    Adhering to the National Technology Transfer and Advancement Act 
of 1995 (Pub. L. 104-113) \8\ and the Office of Management and 
Budget's definition of consensus,\9\ NQF endorses performance 
measures, best practices, serious reportable events, measurement 
frameworks, and reporting guidelines through its formal Consensus 
Development Process,\10\ which is designed to call for input and 
carefully consider the interests of stakeholder groups from across 
the healthcare industry. The strict adherence to this Consensus 
Development Process qualifies NQF as a voluntary consensus 
standards-setting organization, granting its endorsed measures and 
best practices special legal standing. NQF's work can be divided 
into three broad categories:
    1. National Priorities and Goals. In 2008, NQF embarked on the 
nation's largest effort to determine national priorities for 
healthcare quality improvement. NQF convened the National Priorities 
Partnership (NPP), a diverse group of 32 major national 
organizations representing those who receive, pay for, deliver, and 
evaluate healthcare. (See Appendix D.) The NPP, co-chaired by Donald 
M. Berwick, MD, MPP, president and CEO of the Institute for 
Healthcare Improvement, and Margaret E. O'Kane, president of the 
National Committee for Quality Assurance, sought to set in motion a 
national movement to deliver transformative improvements to the 
nation's health and healthcare system. In 2008, the NPP released a 
landmark action agenda, with six priorities to transform healthcare 
during a time of severe economic strain by better investing 
resources to fundamentally improve patient care and outcomes. These 
priorities and the specific, measurable actions springing from them 
guide much of NQF's ongoing work.
    2. Endorsement of Consensus Standards. The careful evaluation 
and endorsement of consensus standards is central to NQF's ongoing 
mission to improve the quality of American healthcare. Using its 
rigorous Consensus Development Process, NQF fosters consensus among 
a wide variety of stakeholders around specific standards that can be 
used to measure and publicly report healthcare quality. NQF endorses 
several different kinds of consensus standards, each of which can be 
used to assess different aspects of healthcare quality: performance 
measures, practices, frameworks, and reporting guidelines. To date, 
NQF has endorsed more than 550 consensus standards.
    [cir] Performance Measures. Measures gauging the performance of 
healthcare endorsed by NQF are used for measuring and publicly 
reporting on the performance of different aspects of the healthcare 
system and are widely viewed as the ``gold standard'' for the 
measurement of healthcare quality. One early model for the 
implementation of NQF endorsed performance measures was National 
Voluntary Consensus Standards for Hospital Care: An Initial 
Performance Measure Set.\11\ This report contained 39 performance 
measures gauging the quality of care delivered in hospitals. It was 
endorsed through NQF's Consensus Development Process. These hospital 
measures took on additional importance when 10 of them became the 
``starter set'' of measures employed by the Hospital Quality 
Alliance \12\ and CMS's Hospital Compare \13\ to encourage public 
reporting of hospital performance measures.
    [cir] Patient Safety. NQF has an established track record of 
national leadership regarding patient safety. Two of its very early 
projects launched NQF's work in this area. The first was Serious 
Reportable Events in Healthcare: A Consensus Report,\14\ in which 
NQF named 27 events leading to death or serious injury that should 
not occur in any healthcare setting, but unfortunately do, and 
should be publicly reported when they do occur. These events and 
their NQF revisions became the cornerstone of many state-based 
adverse event-reporting initiatives and of CMS's policies regarding 
payment for healthcare-acquired conditions. The second was Safe 
Practices for Better Healthcare: A Consensus Report,\15\ a set of 30 
practices that, if universally applied in all clinical care 
settings, would substantially reduce the risk of error and harm for 
patients. These practices have become the standard by which many 
healthcare organizations measure their patient safety goals and 
strategies. Both of these reports have been revised twice since 
initial publication.
    3. Education and Outreach. As part of its ongoing commitment to 
the advancement of healthcare quality, NQF produces a variety of 
publications, such as issue briefs; conducts educational outreach 
sessions such as webinars; sponsors an annual conference that brings 
together healthcare and community leaders to develop national 
solutions to quality concerns; convenes healthcare executives 
annually for an invitational Leadership Colloquium; and sponsors two 
annual recognition programs, the National Quality Healthcare Award 
and the John M. Eisenberg Patient Safety and Quality Awards, 
highlighting the achievements of professionals and providers.
    In 2008, Congress provided a clear mandate and a stable funding 
stream to address gaps and weaknesses that stood between today's 
realities and the creation of a coherent national system for 
establishing performance measures. High-quality standardized 
performance measures are a public need as well as a public good that 
benefits all stakeholders. In 2009, NQF was awarded a contract with 
DHHS under the Medicare Improvements for Patients and Providers Act 
of 2008 (Pub. L. 110-275). The contract provided $10 million for 
year after

[[Page 65348]]

award, with the option for three $10 million annual renewals. This 
contract granted NQF a stable source of core funding to pursue this 
important work in a coordinated, strategic manner.
    Today, NQF is one of the largest consensus-based organizations 
in healthcare in the United States. Its more than 400 organizational 
members represent every aspect of the U.S. healthcare system. It has 
evolved into a truly broad, fully representational organization 
supporting the nation's quest for a ``true north'' for healthcare 
quality. Its strength lies in the active participation of its broad, 
diverse membership. NQF's unique structure enables private- and 
public-sector stakeholders to work together to craft and implement 
cross-cutting solutions to drive continuous quality improvement in 
the American healthcare system. NQF remains committed to maintaining 
a constant drumbeat for healthcare quality.

Appendix B: NQF Board of Directors

William L. Roper, MD, MPH (Chair), Dean, School of Medicine, Vice 
Chancellor for Medical Affairs and CEO, UNC Health Care System, 
University of North Carolina at Chapel Hill.
John C. Rother, JD (Vice Chair), Executive Vice President for Policy 
and Strategy, AARP.
Gerald M. Shea (Secretary), Assistant to the President for External 
Affairs, AFL-CIO.
Richard J. Baron, MD, President and CEO, Greenhouse Internists.
Bruce Bagley, MD, Medical Director for Quality Improvement, American 
Academy of Family Physicians.
Lawrence M. Becker, Director, HR Strategic Partnerships, Xerox 
Corporation.
JudyAnn Bigby, MD, Secretary of Health & Human Services, 
Commonwealth of Massachusetts.
Carolyn M. Clancy, MD, Director, Agency for Healthcare Research and 
Quality.
Francis S. Collins, MD, PhD, Director, National Institutes of 
Health.
Janet Corrigan, PhD, MBA, President and CEO, National Quality Forum.
Maureen Corry, MPH, Executive Director, Childbirth Connection.
Helen Darling, MA, President, National Business Group on Health.
Charlene Frizzera, Acting Administrator, Centers for Medicare & 
Medicaid Services.
Robert Galvin, MD, Director of Global Healthcare, General Electric.
Wade Henderson, Esq., President and CEO, Leadership Conference on 
Civil Rights.
Karen Ignagni, MBA, President & CEO, America's Health Insurance 
Plans.
Chris Jennings, President, Jennings Policy Strategies, Inc.
Charles N. ``Chip'' Kahn III, MPH, President, Federation of American 
Hospitals.
Peter V. Lee, JD, Executive Director of National Health Policy, 
Pacific Business Group on Health.
Mark B. McClellan, MD, PhD, Director, Engelberg Center for 
Healthcare Reform, Senior Fellow for Economic Studies, and Leonard 
D. Schaeffer Chair in Health Policy Studies, The Brookings 
Institution.
Sheri S. McCoy, MBA, Worldwide Chairman of the Pharmaceuticals 
Group, Johnson & Johnson.
Harold D. Miller, President and CEO, Network for Regional Healthcare 
Improvement.
Mary Naylor, PhD, RN, Marian S. Ware Professor in Gerontology at the 
University of Pennsylvania School of Nursing, and Director of 
NewCourtland Center for Transitions and Health.
Debra L. Ness, President, National Partnership for Women and 
Families.
Nancy H. Nielsen, MD, PhD, Immediate Past President, American 
Medical Association.
Samuel R. Nussbaum, MD, Executive Vice President & Chief Medical 
Officer, WellPoint, Inc.
J. Marc Overhage, MD, PhD, Director of Medical Informatics, 
Regenstreif Institute.
Bernard M. Rosof, MD, Chair, Board of Trustees, Huntington Hospital.
Joseph R. Swedish, President and CEO, Trinity Health.
Curt Selquist (Chair, Leadership Network, ex officio), Johnson & 
Johnson Healthcare Systems, Inc. (retired).
John Tooker, MD, MBA, FACP, Executive Vice President and CEO, 
American College of Physicians.
Richard J. Umbdenstock, MS, FACHE, President and CEO, American 
Hospital Association.
Andrew Webber, President and CEO, National Business Coalition on 
Health.

Appendix C: Key NQF Staff Working Under the DHHS

Janet M. Corrigan, PhD, MBA, President and Chief Executive Officer.
Helen Burstin, MD, MPH, Senior Vice President for Performance 
Measures.
Floyd Eisenberg, MD, MPH, FACP, Senior Vice President for Health 
Information Technology.
Laura Miller, MPA, Senior Vice President and Chief Operating 
Officer.
Thomas Valuck, MD, MHSA, JD, Senior Vice President for Strategic 
Partnerships.
Karen Adams, PhD, Vice President of National Priorities.
Alicia C. Aebersold, Vice President of Communications.
Marybeth A. Farquhar, PhD, MSN, RN, Vice President for Performance 
Measures.
Lawrence D. Gorban, MA, Vice President of Operations.
Bruce Pelleu, CPA, Chief Financial Officer.
Peter B. Angood, MD, FRCS(C), FACS, FCCM, Senior Advisor, Patient 
Safety.
Alexis Forman, MPH, Program Director, Performance Measures.
Margaret Kay, Director of Publications.
Lindsay Lang, MHSA, RN, Program Director, Performance Measures.
Nicole Williams McElveen, MPH, Program Director, Performance 
Measures.
Karen Pace, PhD, RN, Senior Program Director.
Ashlie Wilbon, MPH, RN, Program Director, Performance Measures.

Appendix D: National Priorities Partnership

AAR
AFL-CIO
Agency for Healthcare Research and Quality
Aligning Forces for Quality
Alliance for Pediatric Quality
America's Health Insurance Plans
American Board of Medical Specialties
American Health Care Association
American Nurses Association
AQA
Centers for Disease Control and Prevention
Centers for Medicare & Medicaid Services
Certification Commission for Health Information Technology
Consumers Union
Hospital Quality Alliance
Institute for Healthcare Improvement
Institute of Medicine
Johnson & Johnson
Leapfrog Group
National Association of Community Health Centers
National Business Group on Health
National Committee for Quality Assurance
National Governors Association
National Institutes of Health
National Partnership for Women & Families
National Quality Forum
Pacific Business Group on Health
Physician Consortium for Performance Improvement convened by the 
American Medical Association
PQA
Quality Alliance Steering Committee
The Joint Commission
U.S. Chamber of Commerce

Notes

    \1\ Kohn LT, Corrigan JM, Donaldson MS, eds. To Err is Human: 
Building a Safer Health System. Committee on Quality of Health Care 
in America, Institute of Medicine. Washington, DC: National Academy 
Press; 2000.
    \2\ Medicare Improvements for Patients and Providers Act (Pub. 
L. 110-275). Available online at http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=110_cong_bills&docid=f:h6331enr.txt.pdf. 
Last accessed December 2009.
    \3\ National Priorities Partnership (NPP). Available online at 
http://www.nationalprioritiespartnership.org/. Last accessed 
December 2009.
    \4\ NPP. National Priorities & Goals: Aligning Our Efforts to 
Transform America's Healthcare. Washington, DC: National Quality 
Forum (NQF); 2008.
    \5\ NQF. Policy Brief: HITEP II. Issue Brief No. 17; October 
2009. Washington, DC: NQF; 2009.
    \6\ International Classification of Diseases. Available at 
http://www.who.int/classifications/icd/en/. Last accessed January 
2010.
    \7\ President's Advisory Commission on Consumer Protection and 
Quality in the Health Care Industry. Quality First: Better Health 
Care for All Americans. March 12, 1998. Available online at http://www.hcqualitycommission.gov/final/. Last accessed December 2009.
    \8\ National Technology Transfer and Advancement Act of 1998 
(Pub. L. 104-113). Available online at http://ts.nist.gov/standards/information/113.cfm. Last accessed December 2009.
    \9\ U.S. Office of Management and Budget. Circular No. A-119, 
February 10, 1998.

[[Page 65349]]

Available online at http://www.whitehouse.gov/omb/rewrite/circulars/a119/a119.html. Last accessed December 2009.
    \10\ NQF. NQF Consensus Development Process, v. 1.8. Available 
online at http://www.qualityforum.org/Measuring_Performance/Consensus_Development_Process.aspx. Last accessed December 2009.
    \11\ NQF. National Voluntary Consensus Standards for Hospital 
Care: An Initial Performance Measure Set. Washington, DC: NQF; 2003.
    \12\ Hospital Quality Alliance: Improving Care Through 
Information. Available online at http://www.hospitalqualityalliance.org/. Last accessed December 2009.
    \13\ Hospital Quality Compare--A quality tool provided by 
Medicare. Available online at www.HospitalCompare.hhs.gov. Last 
accessed December 2009.
    \14\ NQF. Serious Reportable Events in Healthcare: A Consensus 
Report. Washington, DC: NQF; 2002.
    \15\ NQF. Safe Practices for Better Healthcare: A Consensus 
Report. Washington, DC: NQF; 2003.

IV. Secretarial Comments on the Annual Report to Congress

    The Secretary is pleased with the scope and vision of NQF's March 
2010 annual report. 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. 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.
    Over the past year NQF began work on several tasks outlined in the 
Statement of Work, including: Development of a national strategy for 
performance measurement and prioritization of measures for development 
and endorsement; an evaluation of NQF's consensus development process; 
several measure endorsement projects focused on measure gap areas such 
as outcomes measures and patient safety measures; maintenance of 
currently NQF-endorsed measures; promotion of Electronic Health Records 
through such activities as the development of the ``E-measure'' and the 
retooling of a subset of existing NQF-endorsed measures into E-measure 
format; development of a public website to make available current NQF 
activities; endorsement of efficiency and resource use measures. The 
Secretary is pleased with the progress and timeliness of the work 
outlined in the Annual Report.

V. Future Steps

    The consensus based contract with NQF is a four year contract. 
During the first full performance year of the contract, NQF completed 
deliverables for each task. HHS will continue to task NQF with single 
year and multi-year projects.

Formulation of National Strategy and Priorities for Health Care 
Performance Measurement

    During March 2009 to February 2010, NQF created 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 established a steering committee to 
oversee the prioritization process and to consider additional 
measurement streams (e.g. population health, child health, Health IT) 
in its prioritization process.

Consensus Development Process for Measure Endorsement

    During March 2009 to February 2010, NQF established steering 
committees to consider endorsement of outcomes measures in 3 phases. 
The first 2 phases will endorse outcomes measures for patients with 
Medicare high priority conditions. The third phase will endorse 
outcomes measures for mental health and for children. Future steps also 
include the endorsement of measures for patients in Nursing Homes as 
well as Patient Safety measures.

Maintenance of Consensus Endorsed Measures

    During March 2009 to February 2010, NQF maintained 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 March 2009 to February 2010, NQF supported the promotion of 
electronic health records as part of HHS-wide efforts. NQF developed 
the Health Quality Measure Format (HQMF, or ``E-measure''), began the 
retooling process to convert a sub-set of currently endorsed measures 
into E-Measure format, and supported the HIT Standards Panel in 
developing code lists and vocabulary standards for the transition to 
performance measurement through Electronic Health Records. Future steps 
include the retooling of the remaining subset of currently endorsed 
measures, the development of a measure authoring tool for creating E-
measures, and to support clinical decision support systems for 
measuring and reporting performance. NQF will also support the 
selection of performance measures for the Meaningful Use of electronic 
health records.

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

    During March 2009 to February 2010, NQF supported 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/.

VI. 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: October 15, 2010.
Kathleen Sebelius,
Secretary, Department of Health and Human Services.
[FR Doc. 2010-26795 Filed 10-21-10; 8:45 am]
BILLING CODE 4150-05-P