NQF-Convened Group Provides Recommendations to HHS for Hospital and Post-Acute Care Long-Term Care Value-Based Purchasing Programs 

Washington, DC – The National Quality Forum’s (NQF) Measure Applications Partnership (MAP) submitted recommendations to the Department of Health and Human Services (HHS) regarding issues to consider when selecting performance measures for both hospitals and post-acute care/long-term care (PAC/LTC) settings. The new reports follow recommendations shared with HHS earlier this month for approximately 200 performance measures under consideration for use in 20 federal healthcare programs, 67 of which apply specifically to hospitals and PAC/LTC settings.

“MAP’s pre-rulemaking recommendations to HHS are an important contribution to the development of value-based payment and purchasing programs that shape healthcare for our nation’s 50 million Medicare beneficiaries,” said Christine K. Cassel, MD, NQF president and CEO. “This guidance reflects consensus among 150 experts from all areas of healthcare, as well as the public comments MAP received on its work.”

In its Considerations for Selection of Measures for Federal Programs: Hospitals report, MAP identified several overarching issues, including the need for high-value measures that are meaningful to consumers and will drive significant improvements in the quality and efficiency of care, as well as the need to increase uniformity or alignment across programs. MAP raised a number of alignment challenges, however, including the unique program objectives of individual programs, updating of existing measure specifications, and balancing shared accountability for patient outcomes with appropriate attribution of responsibility to providers.

MAP reviewed measures under consideration for nine hospital- and setting-specific programs, including Hospital Inpatient Quality Reporting (IQR), Hospital Value-Based Purchasing (VBP), the Hospital Readmissions Reduction Program (HRRP), the Hospital-Acquired Condition Reduction Program (HAC), Hospital Outpatient Quality Reporting (OQR), Ambulatory Surgical Center Quality Reporting (ASCQR), the Medicare and Medicaid EHR Incentive Program for Hospitals and Critical Access Hospitals (CAHs) (Meaningful Use), Prospective Payment System (PPS)-Exempt Cancer Hospital Quality Reporting (PCHQR), and Inpatient Psychiatric Facility Quality Reporting (IPFQR).

In its Considerations for Selection of Measures for Federal Programs: Post-Acute Care/Long-Term Care report, MAP recommended that HHS emphasize moving to similar measures to promote patient-centered care across PAC/LTC programs, coordinate efforts between patient assessment instruments used in PAC/LTC settings to maintain competencies and quality-of-care data, and align performance measurement across PAC/LTC settings to ensure comparability of performance and to facilitate information exchange.

MAP reviewed measures under consideration for five setting-specific programs addressing post-acute care and long-term care, including the Inpatient Rehabilitation Facility Quality Reporting Program (IRF QRP), the Long-Term Care Hospital Quality Reporting Program (LTCH QRP), the End-Stage Renal Disease Quality Incentive Program (ESRD QIP), the Skilled Nursing Facility Value-Based Purchasing Program (SNF VBP), and the Home Health Quality Reporting Program (HH QRP).

MAP also made specific recommendations for the programs in the reports. For example, MAP noted that the Hospital Readmissions Reduction Program should recognize that not all readmissions denote poor quality, so planned and unrelated readmissions should be excluded from the measures in the program. 

The National Quality Forum leads national collaboration to improve health and healthcare quality through measurement. Learn more at www.qualityforum.org.