Improving the Measurement of Physician Quality

Many stakeholders accept that the U.S. health care system can improve the quality of care it delivers. Developing quantifiable ways to measure quality across the health care spectrum is a national priority.

The Centers for Medicare & Medicaid Services (CMS) Quality Initiative was launched in 2002 with the Nursing Home Quality Initiative and expanded in 2003 with the Home Health Quality Initiative and the Hospital Quality Initiative. In 2004, the Physician Focused Quality Initiative was developed. It includes the Doctor's Office Quality Project, which builds on ongoing CMS strategies and quality improvement programs in health care settings to (1) assess the quality of care for key illnesses and clinical conditions that affect many Medicare beneficiaries, (2) support clinicians in providing appropriate treatment of the conditions identified, and (3) promote health care quality and reduce preventable illness.

Mathematica is working with its subcontractors, the American Medical Association (AMA) and the National Committee for Quality Assurance (NCQA), to develop and expand physician quality measures where the existing measures are not applicable or where there are too few measures. Using administrative data from electronic health records or paper medical records, as well as other relevant claims-based or administrative data sources, we are selecting and developing measures for quality improvement and intervention, public reporting, and pay-for-performance demonstrations and for use by quality improvement organizations. The measures will, to the extent possible, be grounded in the Institute of Medicine's principles of quality care.

New Measures Unveiled. In July 2006, the research team released the first in a series of physician quality measures for public comment that focus on specialty care. Over the course of the study, eight sets of specialty measures will be released in three phases for public comment. The first measures released involve eye care, osteoporosis, and perioperative care. Additional measures relate to stroke care, skin cancer, geriatrics, emergency care, and gastroesophageal reflux disease.

Mathematica is coordinating all project-related activities, convening two technical expert panel meetings, conducting formative testing of the measures, ensuring adherence to CMS's measures management system, and writing the final report. The AMA is assembling the technical expert panel, identifying measures, and performing GAP analysis, as well as compiling a candidate list of measures. NCQA is developing and disseminating the measures input document, as well as drafting technical specifications.

This project is funded by the Centers for Medicare & Medicaid Services.

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