Final Publications:
The Opportunity
As current health reform efforts focus on expanding coverage to affordable care, it is important to understand how the system uses resources in the context of health outcomes. Aligning resource use (or cost) and quality data will enable the system to better evaluate efficiency care. By improving efficiency, there is potential to reduce the rate of cost growth and improve the value of care provided. Evidence shows that not all care leads to better outcomes, thus some portion of these current costs may be unnecessary. To identify and provide incentives for providers to deliver high quality, lower-cost care requires quality and resource use measures.
The NQF episodes measurement framework specifically highlighted the need for the delivery system to improve health and reduce the burden of illness while maximizing the value of individual and societal resources allocated to health care. In that framework, NQF adopted the following definition of efficiency: a measure of cost of care associated with a specified level of quality of care. Since efficiency measurement is multidimensional, encompassing quality and costs, this effort focuses on identifying and evaluating resource use measures as a building block toward measuring efficiency.
About the Project
Phase II of this project began in January 2011.
The first phase of this resource use measurement project included the development of a paper and expanded criteria to evaluate resource use measures. The whitepaper can be accessed here.
In this phase NQF is evaluating and endorsing resource use measures for reporting at multiple levels, including the individual and group physician level. This consensus development project specifically includes evaluation of resource use measures, including per capita and episode-based measures for 13 disease and condition areas.
Review Cycle 1 | Review Cycle 2 |
- Congestive Heart Failure (CHF)
- Coronary artery disease (CAD)
- Acute myocardial infarction (AMI)
- Stroke
- Diabetes
- Cross-cutting/Non-condition specific
(e.g., per capita-population)
| - Chronic obstructive pulmonary disease (COPD)
- Asthma
- Pneumonia
- Breast cancer
- Colorectal cancer
- Hip/Knee replacement
- Hip/Pelvic fracture
- Low back pain
|
Process
The work of Phase II is being overseen by a Steering Committee. Four technical advisory panels (TAPs) offered clinical expert review of candidate measures. In accordance with the two review cycles, there were two calls for measures within the project, each for separate sets of conditions. Measures from both phases were be open for public and member comment and subsequent member voting. Candidate resource use measures are being considered for NQF endorsement as national voluntary consensus standards. Agreement will be developed through NQF’s Consensus Development Process (CDP, Version 1.8). This project is guided by a Steering Committee of representatives from across the spectrum of healthcare stakeholders that considers and makes recommendations regarding comments from healthcare stakeholders and existing NQF reports and prior work.
Funding
This project is funded under NQF's contract with the Department of Health and Human Services, Consensus-based Entities Regarding Healthcare Performance Measurement.
Related NQF Work
Contact Information
For further information, contact Ashlie Wilbon, RN, MPH 202-783-1300 or via e-mail at efficiency@qualityforum.org.
This consensus development project will specifically include evaluation of resource use measures, including per capita and episode-based measures for 13 specific diseases and conditions across two review cycles.
NQF has issued a Calling for Nominations for all Technical Advisory Panels (TAPs) during Phase II of this project. The Call for Nominations for the Steering Committee for Phase I closed on December 24, 2009.
Steering Committee Roster (PDF)
Steering Committee Bios (PDF)
NQF sought a wide range of stakeholder perspectives to provide expertise on Efficiency: Resource Use: Phase II. The Call for Nominations for Technical Advisory Panel (TAP) members closed on March 1, 2011. For more information, please reference the Call for Nominations document.
The 14-day review period for the CV/Diabetes and Bone/Joint TAPs submitted nominees closed on April 18, 2011.
The 14-day review period for the Cancer and Pulmonary TAPs submitted nominees closed on April 18, 2011.
NQF has issued a Call for Candidate Standards for Efficiency: Resource Use, Phase II.
For instructions and guidance on to how to submit a Resource Use measure please view presentation materials.
The Steering Committee and the TAPs began meeting in June 2011 to evaluate the submissions and prepare the draft reports.
Measure Use Evaluation Criteria (PDF)
Efficiency: Resource Use held a General Methods webinar on April 25, 2011. The webinar was open to NQF members and the public.
The Steering Committee met on May 2, 2011 via webinar to discuss the two Non-Condition Specific measures.
Agenda (PDF)
Meeting Recording (MP3)
Meeting Transcript (PDF)
Meeting Summary (PDF)
Non-Condition Specific Measures
1598 - Total Cost of Care and Resource Use Population-based PMPM Index
1599 - ETG Based Non-Condition Specific resource use measure
1604 - Total Cost of Care Population-based PMPM Index
The CV/Diabetes TAP met in-person on May 10-11, 2011 in Washington, DC. The meeting was open to NQF Members and the public. It was accessible online and via dial in.
Cardiovascular/Diabetes Measures
1557 - Relative Resource Use for People with Diabetes
1558 - Relative Resource Use for People with Cardiovascular Conditions
ZIP files
To access files, click on the measure number below and download the ZIP file by saving it to your desktop. The individual files must be extracted from the ZIP file and saved to your computer (they will not directly open from the ZIP file).
1591 - ETG Based Congestive Heart Failure (CHF) resource use measure
1594 - ETG Based Coronary Artery Disease (CAD) resource use measure
1595 - ETG Based Diabetes resource use measure
The Steering Committee met via webinar on June 6, 2011 to discuss the non-condition specific measures.
The Steering Committee met via webinar on June 9, 2011 to discuss the three cardiovascular and diabetes measures.
The Steering Committee met via conference call on June 22, 2011 to discuss the remaining cardiovascular/diabetes measures.
The Steering Committee met on June 29-30, 2011 to discuss the 14 cardiovascular and diabetes measures. The meeting was held in Washington DC and was open to NQF Members and the public.
Agenda (PDF)
Meeting Transcripts (PDF): June 29 | June 30
The Bone/Joint TAP met on July 7, 2011 to discuss the four Bone and Joint measures. The meeting was held in Washington, DC and was open to NQF Members and the public.
Bone/Joint Measures
1603 - ETG Based Hip Fracture cost of care measure (Ingenix)
1609 - ETG Based Hip/Knee Replacement cost of care measure (Ingenix)
The CV/Diabetes TAP met via conference call on July 14, 2011 to discuss four Cardiovascular measures.
The Steering Committee met via conference call on July 15, 2011 to discuss four measures.
The Pulmonary TAP met on July 19, 2011 to discuss the ten Pulmonary measures.
Agenda (PDF)
Meeting Summary (PDF)
Meeting Transcript (PDF)
Pulmonary Measures
1605 - ETG Based Asthma cost of care measure (Ingenix)
1608 - ETG Based Chronic Obstructive Pulmonary Disease (COPD) cost of care measure (Ingenix)
1611 - ETG Based Pneumonia cost of care measure (Ingenix)
1560 - Relative Resource Use for People with Asthma (NCQA)
1561 - Relative Resource Use for People with COPD (NCQA)
The Bone/Joint TAP are expected to meet on August 5.
The Steering Committee met August 30-31 to discuss Cancer, Bone/Joint and Pulmonary Measures. The meeting was open to NQF members and the public.
Members had 15 days to submit their vote.
The draft report has been revised based on the comments received during the Public and Member Comment and consultation with the Steering Committee. Member voting closed on November 7, 2011.
NQF project staff hosted a voting webinar on October 26 with a member of CSAC and a co-chair from the committee.
The draft report has been revised based on the comments received during the Public and Member Comment and consultation with the Steering Committee. Member voting closed on February 3, 2011.
NQF project staff hosted a voting webinar on Friday, January 27 with a member of CSAC and a co-chair from the committee.
CSAC is scheduled to meet at the end of 2011 through the beginning of 2012. In these meetings, the CSAC is expected to consider endorsement of Efficiency: Resource Use Phase II measures.
CSAC met in-person on November 2-3; during this meeting, the CSAC began discussing endorsement of Non-Condition Specific and CV/Diabetes measures.
CSAC met on December 12, 2011 to consider endorsement of the four Resource Use measures from Cycle 1.
CSAC is scheduled to meet on February 13, 2012. In this meeting, the CSAC is expected to consider endorsement of the CV/Diabetes, Pulmonary, and Bone/Joint measures.
Resource Use Ignenix Reconsideration Memo (PDF)
After the CSAC makes its decision with each set of measures, the NQF Board has seven days to ratify any endorsements. Any information pertaining to the Board’s deliberations will be posted when available.
No appeals were filed during this time.
No appeals were filed during this time.
