NQF’s endorsement processes reflect five key attributes—openness, balance of interest, due process, appeals, and consensus. Recent NQF efforts to broker compromise on modifications for an endorsed dialysis readmissions measure offer an informative case study of how NQF put these attributes into action.
Measure #2496, Standardized Readmission Ratio (SRR) for Dialysis Facilities, tracks the number of unplanned hospital readmissions within 30 days of discharge for Medicare-covered dialysis patients treated at a particular dialysis facility. The All-Cause Admissions and Readmissions Standing Committee evaluated the measure using NQF’s evaluation criteria: importance to measure; scientific acceptability (including reliability and validity); usability and use; and feasibility. While the committee felt that the measure was important and scientifically acceptable, concerns about which entity will be held accountable for this measure, i.e., its attribution, dominated the standing committee’s discussion, and the committee did not reach consensus.
Public comments on this measure, mainly from dialysis providers, also raised concerns about the measure’s attribution to dialysis facilities as well as about risk adjustment for socioeconomic factors, testing, the intended use of the measure, and potential unintended consequences.
To address these concerns, NQF undertook an extensive consensus-building process to identify an agreeable path forward among the various stakeholders. An essential component was NQF’s effort to bring the measure developer, the Centers for Medicare & Medicaid Services (CMS), together with representatives of the dialysis community and facilitate improved understanding of differing perspectives, perceived challenges, and potential solutions.
This effort resulted in modifications to the measure as well as agreement to work together over the next year to identify and test additional risk-adjustment factors. CMS also will identify a mechanism by which dialysis facilities can have access to more timely information on their readmission rates.
“This intensive consensus-building effort focused on building trust among the parties and identifying how the measure specifications can evolve to address the methodological concerns raised by the renal community,” said Helen Burstin, MD, MPH, NQF chief scientific officer. “Striking a balance among the needs of other stakeholders also was critical to advance the readmissions measurement for this important patient population.”