Report: NQF’s MAP Recommends HHS Remove Ineffective Quality Measures

March 16, 2017
The Washington, DC-based National Quality Forum’s (NQF) Measure Applications Partnership (MAP) on Thursday issued guidance to the U.S. Department of Health and Human Services (HHS) recommending significant improvements to measure sets used in federal programs.

The Washington, DC-based National Quality Forum’s (NQF) Measure Applications Partnership (MAP) on Thursday issued guidance to the U.S. Department of Health and Human Services (HHS) recommending significant improvements to measure sets used in federal programs.

Specifically, the NQF’s MAP guidance proposes that HHS consider the future removal of 51 of 240 measures currently used in seven federal healthcare value-based purchasing, public reporting and other programs, or about 20 percent of the metrics HHS uses to determine payment in those seven federal healthcare programs. MAP's analyses and guidance aims to define new ways to ensure quality measurement is improving healthcare for patients while reducing burden for clinicians and other providers.

MAP also provides recommendations for improving measure sets used in nine additional federal programs. “In order for the Centers for Medicare & Medicaid Services (CMS) to act on these recommendations, it will likely need to engage in rulemaking as well as consider other programmatic needs not taken into account by the MAP process,” the agency stated in a press release about the report.

The full list of 51 measures recommended for removal can be assessed in the NQF’s MAP report, "Maximizing the Value of Measurement: MAP 2017 Guidance," here.

Convened in 2011, MAP is a public-private partnership that provides recommendations to HHS on the use of quality and efficiency measures in federal public reporting and value-based payment programs. More than 150 healthcare leaders from 90 organizations who regularly use measures and measurement information participate in MAP discussions. In its 2017 guidance, MAP addresses the importance of removing measures that are no longer driving improvements in patient care or that do not meet the rigorous scientific criteria for NQF endorsement.  

Chip Kahn, president and CEO of the Federation of American Hospitals, who co-chairs the MAP Coordinating Committee, said in a statement that the MAP process “fosters a focus on high-value measures that will improve care quality and outcomes for patients.”

Harold Pincus, M.D., professor and vice chair of psychiatry at Columbia University and director of quality and outcomes research at New York-Presbyterian Hospital, also co-chair of the MAP Coordinating Committee, said, “Getting to measures that matter for improving patient care without creating unnecessary administrative burdens is a balancing act. To get it right, we need more feedback from patients, frontline doctors, and other healthcare professionals on what works and what needs improvement in healthcare quality measurement.”

MAP guidance on future removal of measures includes:

  • ESRD Quality Incentive Program: 4 measures suggested for removal; 18 current measures
  • PPS-Exempt Cancer Hospital Quality Reporting Program: 4 measures suggested for removal; 17 current measures
  • Ambulatory Surgery Center Quality Reporting Program: 2 measures suggested for removal; 15 current measures
  • Inpatient Psychiatric Facility Quality Reporting Program: 7 measures suggested for removal; 20 current measures
  • Outpatient Quality Reporting Program: 13 measures suggested for removal; 29 current measures
  • Inpatient Quality Reporting Program: 6 measures suggested for removal; 62 current measures
  • Home Health Quality Reporting Program: 15 measures suggested for removal; 79 current measures

In the report, MAP continues to encourage a person-centered focus to healthcare delivery, including greater use of patient-reported outcome-based performance measures.

“Consumers, patients, and purchasers are looking to NQF and MAP to get to the best measures, even if they are difficult to report,” said Helen Burstin, M.D., NQF’s chief scientific officer, said in a statement. “They’re counting on us to get it right.”

Further, in the report, MAP stresses the need for a systematic process to incorporate qualitative and quantitative feedback from organizations and providers who implement and use measures and voiced support for NQF’s efforts to gather input from the field about measures.

Additionally, MAP notes that higher value measures, including outcome measures, are needed in the Merit-Based Incentive Payment System (MIPS) and Medicare Shared Savings Program (MSSP).

In its specific recommendations regarding measures for MIPS, MAP stresses the importance of selecting high-quality measures that drive toward safer and more efficient care. Although MAP does not recommend the removal of any measures from MIPS, it emphasizes the need for measures that will drive meaningful improvements in care. MAP recognizes that removal of measures from MIPS must be balanced with the need to ensure all eligible clinicians can participate, according to a NQF press release about the recommendations.

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