On July 23, 2014, the NQF Board voted overwhelmingly to ratify a time-limited, robust trial period to assess the impact of risk adjusting relevant quality measures for socioeconomic (SES) status and other demographic factors. The data collected from this trial will inform whether NQF makes a permanent change to its risk adjustment policy.
For months, NQF has been at the forefront of a national discussion about whether measures should be risk adjusted for SES. With funding by the Centers for Medicare and Medicaid Services (CMS), NQF convened an Expert Panel to consider the challenging issue of whether or not to adjust performance measures and the effects on patients and providers. The majority of the Expert Panel concluded that the NQF policy prohibiting adjustment for SES could unintentionally weaken the network of providers that serve disadvantaged populations and potentially worsen health care disparities. The panel recommended that NQF change its policy to allow for SES adjustment of certain measures under certain conditions. After extensive public comment, the panel amended its recommendations in important ways, including requiring stratification to identify disparities when a measure is risk adjusted, calling for an NQF standing disparities committee, and recommending a transition period for the SES policy change.
NQF’s Consensus Standards Approval Committee (CSAC), which advises the NQF Board on performance measurement, recommended that the impact of SES adjustment should be tested in a trial to inform NQF’s future, permanent policy. The NQF Board agreed and ratified the Expert Panel’s recommendations to stratify an adjusted measure to identify disparities and to empanel a standing disparities committee. The Board also recommended that the trial compare SES and clinically adjusted measures to measures that are only clinically adjusted to generate the knowledge and data needed to consider a policy change. The Expert Panel’s final report was delivered to CMS on August 15.
“We are committed to working with NQF to identify appropriate measures for consideration during the pilot,” said Patrick Conway, MD, CMS deputy administrator for innovation and quality and chief medical officer.
While the specifics of the trial period are still being developed, NQF encourages measure developers to bring SES adjusted measures forward for consideration. In the months ahead, NQF will provide further details about the trial and issue a call for nominations for its new standing disparities committee.
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