Today, 55 million Americans are Medicare beneficiaries. As their ranks continue to grow, the program is driving the transformation of the nation’s healthcare delivery system to reward quality of care and value over payment for volume of services. Quality measurement is integral to this effort.

Since NQF’s founding in 1999, Medicare’s commitment to quality measurement catalyzed NQF’s multistakeholder effort to endorse best-in-class measures. Over time, this work has taken on increasingly complex measurement science issues. Today, NQF is examining issues such as risk adjusting performance measurement for socioeconomic status and other demographic factors, the measurement burden on clinicians, and whether measures should be endorsed—with potentially different criteria—for different uses, such as internal quality improvement programs or pay-for-performance initiatives.

Medicare’s use of measures has led to powerful tools for patients to understand their healthcare needs and for providers to focus their quality improvement efforts. Star rating systems help consumers, their families, and caregivers to compare nursing homes, hospitals, home health agencies, and even health plans. Meanwhile, pay-for-performance programs such as the Hospital Readmissions Reduction Program, the Value-Based Purchasing Program, and the Hospital-Acquired Condition Reduction Program have changed how hospitals deliver care. Together, these efforts are reaping results. A recent study in the Journal of the American Medical Association (JAMA) found that mortality rates among Medicare fee-for-service patients decreased 16 percent from 1999 to 2013, while hospitalizations decreased 24 percent and costs for hospitalized patients fell 15 percent.

“It’s a jaw-dropping finding,” said the lead author of the study, Yale University School of Medicine cardiologist Harlan Krumholz, MD, in USA Today. “We didn’t expect to see such a remarkable improvement over time.”

The researchers write in JAMA that “there is evidence for improvements in process measures for many conditions that affect large numbers of beneficiaries, as well as outcomes for specific conditions.” The findings may also in part reflect healthier behaviors as well as technological advances, for example, cancer therapies that extend life and treatments that have lessened mortality associated with cardiovascular disease.

Considerable work remains to fill gaps in measurement capabilities in important areas, according to NQF’s CEO Christine K. Cassel. In Generations: Journal of the American Society on Aging, Cassel noted that more work is needed to “hear directly from patients about their health” and to make it easier for patients to communicate with their providers.

“While we have accomplished much to assess and improve quality in a relatively short time frame, considerable work remains to attain the high-value and high-quality healthcare system providers want and patients need,” she wrote.

NQF is working to address measurement gaps. For example, a recently launched pediatric measures project aims to strengthen health and healthcare for children. Recent measures endorsed by NQF that fill gaps include resource use measures and readmissions measures beyond those for hospitals.