NQF Endorses Measure Assessing Cost of Services for Hospitalized Medicare Beneficiaries 

Washington, DC – The National Quality Forum (NQF) Board of Directors has endorsed a measure that assesses total cost of services for hospitalized Medicare beneficiaries—including costs incurred prior to, during, and following a hospital stay. This measure is currently in use in the Centers for Medicare & Medicaid Services’ (CMS) Hospital Inpatient Quality Reporting Program, as well as its Hospital Value-based Purchasing Program.

“When looked at with measures of quality, measures that show how healthcare dollars are being spent can help us understand where to make improvements and efficiencies in care delivery,” said Eugene Nelson, DSc, MPH, Director of the Population Health Measurement Program at Dartmouth Institute For Health Policy and Clinical Practice and co-chair of the Cost and Resource Use Steering Committee. “This measure is an important step to achieving that aim.”

The measure was first voted on by NQF membership in October 2013 and did not receive clear support for endorsement, with some stakeholders concerned with the lack of risk adjustment for socioeconomic status—the process of controlling for intrinsic patient factors that could influence outcomes—and that the majority of cost drivers occur in post-acute care settings. Given the disagreement, NQF sought additional input from members to further understand their specific concerns.

“NQF works to foster constructive, collaborative discussions between knowledgeable stakeholders on the toughest issues affecting our healthcare system,” said Christine K. Cassel, MD, President and CEO of NQF. “The complex and controversial nature of this measure demanded further conversation, so NQF made sure members’ voices were effectively heard before any endorsement decision was made.”

After serious consideration of the issues raised by NQF’s membership, the Board of Directors ultimately chose to endorse the measure. The measure is at the heart of complex issues in healthcare—how to hold hospitals accountable for providing high-quality, equitable care while recognizing that disadvantaged populations pose more challenges, and that hospitals currently vary in their ability to influence care decisions after discharge. NQF is taking steps to address these issues, starting with an expert panel focused on risk adjustment and socioeconomic status that will convene in early 2014 to provide further guidance to the field.

“The Steering Committee recognizes that effectively measuring healthcare costs presents significant methodological challenges,” said David Penson, MD, MPH, Hamilton and Howd Chair in Urologic Oncology and Professor of Urologic Surgery and Medicine at Vanderbilt University, and co-chair of the Cost and Resource Use Steering Committee. “These challenges, however, are not insurmountable, and we are encouraged to see so many stakeholders actively engaged in efforts to understand how measures of cost and quality can be used to build a higher-quality healthcare system.”

The robust discussions surrounding the measure prompted the Steering Committee to recommend that further work be considered in this area, specifically focused on the appropriateness of including dual-eligible populations in risk-adjustment models, and on holding hospitals accountable for these costs which largely are occurring outside of their institutions in post-acute settings such as nursing homes and long term care.

The NQF endorsement process allows for reconsideration of the endorsed quality measures listed below by submitting an appeal no later than January 8. To submit an appeal, please go to the Quality Positioning System (QPS), NQF’s Measure Database and premier search tool for endorsed measures.

Endorsed Measure 

• 2158: Payment-Standardized Medicare Spending per Beneficiary (CMS)

NQF operates under a three-part mission to improve the quality of American healthcare by: 

• building consensus on national priorities and goals for performance improvement and working in partnership to achieve them;  
• endorsing national consensus standards for measuring and publicly reporting on performance; and  
• promoting the attainment of national goals through education and outreach programs. 

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