Measuring Performance

Ambulatory Care - Additional Outpatient Measures 2010 

Project Status: Completed

National Voluntary Consensus Standards for Ambulatory Care: Additional Outpatient Measures 2010

Access the Final Report: National Voluntary Consensus Standards for Ambulatory Care—Additional Outpatient Measures 2010  

The Opportunity

The National Quality Forum (NQF) has endorsed a wide variety of ambulatory care measures for assessment of the quality of care provided in outpatient facilities, including hospital outpatient departments (HOPD), emergency departments, urgent care facilities, ambulatory surgery centers, community health centers, and clinician offices. As more NQF-endorsed measures are implemented, the demand for measures to fill important gaps is growing. The implementation and reporting of quality measures for hospital outpatient services builds on previous efforts in the inpatient area, having the same purpose. Endorsement of measures is intended to encourage hospitals and clinicians to improve their quality of care and to empower consumers with quality information to make informed decisions about their healthcare.

Ambulatory medical care is the predominant method of providing healthcare services in the United States and occurs in a wide range of settings. The largest proportion of ambulatory care services occurs in physician offices. Moreover, approximately 11 percent of all ambulatory medical care visits in the United States occur in the ED.1 From 1996 through 2006, the number of ED visits increased from 90.3 million to 119.2 million visits annually, a 32% increase.2 Yet the number of hospital EDs in the United States decreased by about 12.4 percent during the same period. Demand and capacity issues have contributed to increased patient wait-time and decreased physician productivity, placing patients at risk for poor outcomes.

From the Medicare perspective, 17% of ED visits are covered by this payment source. Since 2008, CMS has adopted outpatient measures specifically addressing ED and ambulatory surgical center (ASC) quality of care. CMS projects that total payments for services furnished to people with Medicare in HOPDs during CY 2010 under the Outpatient Prospective Payment System (OPPS) will be $32.2 billion, while total projected CY 2010 payments under the ASC payment system will be approximately $3.4 billion. As of 2010, NQF has endorsed measures for these healthcare facilities, but few measures have been endorsed beyond process measures.


NQF sought to identify and endorse additional measures of outpatient care addressing emergency department and/or urgent care and ambulatory surgery for public reporting and quality improvement.


The candidate measures were considered for NQF endorsement as national voluntary consensus standards. Agreement was developed through NQF’s Consensus Development Process (CDP, Version 1.8). This project involved the active participation of representatives from across the spectrum of healthcare stakeholders. Due to the different expertise required for the two focal areas, two Steering Committees were convened to consider proposed consensus standards.

Related NQF Work 

Contact Information

For further information, contact NQF at 202-783-1300 or via email at


  •  Schappert SM, Rechtsteiner EA. Ambulatory medical care utilization estimates for 2006. National health statistics reports; no 8. Hyattsville, MD: National Center for Health Statistics. 2008. Available from:
  •  Pitts SR, Niska RW, Xu J, Burt CW. National Hospital Ambulatory Medical Care Survey: 2006 emergency department summary. National health statistics reports; no 7. Hyattsville, MD: National Center for Health Statistics. 2008.


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