Quality: Measuring What Matters for Your Healthcare Association
Is healthcare quality important to your members? If you work for a healthcare association, the answer is likely yes. Fierce debates are happening around the country about skyrocketing healthcare costs and attempts to streamline the system. Healthcare is arguably more essential to people than most other goods or services, and we have a strong collective interest in ensuring that the healthcare system works as well as it can. Quite simply, the consequences of poor quality can be deadly.
In addition, financing the rising cost of healthcare is extremely challenging (U.S. healthcare costs dwarf similar spending in other countries), and those paying the bills quite legitimately want to know if they are getting good value for their money. According to healthsystemtracker.org, objective metrics about healthcare performance can assist individuals with their own healthcare decisions, provide context for state and national policy discussions about healthcare programs and investments, and point to where and how the system can be improved.
How Quality Measures Affect Your Members
There are many reasons why your healthcare association should learn more about quality metrics or invest in defining quality in the niche of healthcare that is important to your members. In one way or another, your members either are or will be affected by quality initiatives by the federal government. Wouldn’t they prefer to have a say in what their work gets compared to, rather than have the government define what standard they have to live up to?
The Centers for Medicare & Medicaid Services (CMS) implements quality initiatives to ensure quality health care for beneficiaries through accountability and public disclosure. CMS uses quality measures in its various quality initiatives that include quality improvement, pay for reporting, and public reporting. CMS explains that quality measures are tools that help us measure or quantify healthcare processes, outcomes, patient perceptions, and organizational structure or systems that are associated with the ability to provide high-quality health care or that relate to one or more quality goals for health care, such as effective, safe, efficient, patient-centered, equitable, and timely care.
Defining Quality for Members: An AAHPM Case Study
At the American Academy of Hospice and Palliative Medicine (AAHPM), we started our journey toward helping to define quality for our members in collaboration with the Hospice and Palliative Nurses Association (HPNA) through our Measuring What Matters project, a consensus recommendation for a portfolio of performance measures for all hospice and palliative care programs to use for program improvement. The Top 10 Measures That Matter has become a focal point for our members and a strategic way for AAHPM to move the field forward in navigating the complex world of healthcare quality. The project led to subsequent priority-setting in the areas of
- defining the patient population who could benefit most from palliative care services
- increasing the ways data can be captured in a systematic way through electronic means
- increasing the number of quality measures centered on the patient, caregiver, and family experience of care.
To achieve the priorities above, AAHPM pursued funding from various sources, researched best practices and innovative ways to pursue our members’ goals, convened collaborative organizations and subject-matter experts to do the work, and embarked on three projects to advance the field in terms of quality initiatives:
- AARP provided funding for a project to test whether a commercial claims database could be used to identify patients with serious illness and provide a useful denominator for palliative care quality measures. This project wrapped in July 2019 and a manuscript is forthcoming.
- With the support of a $2.9 million grant from the Gordon and Betty Moore Foundation [and additional funding from the Cambia Foundation], five organizations convened to develop a quality improvement organization (the Palliative Care Quality Collaborative [PCQC]) with a unified registry to capture both program and patient-level quality data to improve the care of patients with serious illness, including those receiving palliative care. AAHPM project manages this initiative. PCQC was incorporated as its own 501c3 this past summer and is AMC’s newest client partner.
- AAHPM, in partnership with the National Coalition for Hospice and Palliative Care and the RAND Corporation, was awarded a $5.5 million cooperative agreement from the Centers for Medicare and Medicaid Services (CMS) to develop patient-reported quality measures for community-based palliative care (Cooperative Agreement #1V1CMS331639-01-00). The project began in September 2018 and will run for 3 years.
Usually, quality measures are developed by contractors to CMS, and the healthcare specialty societies barely get a chance to comment on what matters to them and their members. This time, however, under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), CMS was directed to develop performance measures for clinicians, and they went to medical specialty societies to do it. Through an enormous effort from all different departments of AMC (finance, human resources, grants management) and rapid response from the AAHPM Board, AAHPM received the first federal award that an AMC client has received directly (we are the Prime not a Subrecipient), and by far the largest funding award that has come to AMC.
The Palliative Care Quality Measures Project will develop and test two patient experience measures assessing core patient-centered and patient-reported outcomes in palliative care:
- the adequacy and appropriateness of symptom management, particularly pain
- the experience of feeling heard and understood by palliative care providers.
The members of the Palliative Care Measures Project Team
A Patient-Centered Approach to Measure Development
One of the unique aspects of this project is AAHPM’s commitment to a truly patient-centered approach to measure development. Science doesn’t always go hand in hand with patient input, but this effort strives to value the lived experience of patients, caregivers, and family members as much as the experts. To this end, we’ve established a Technical Expert Clinical User Patient Panel (TECUPP) instead of a simple Technical Expert Panel (TEP) to keep the focus on the patient, first and foremost, while creating cross-cutting measures, applicable broadly to seriously ill patients and their families receiving palliative, primary, and specialty care. Our mantra is simply “for us, by us,” meaning we will create the measures with patient, caregiver, and family input along with essential input from clinical-end users from the palliative care field throughout the measure development, testing, and implementation process.
How Your Association Can Practice Quality Improvement
If your association is considering focusing on quality improvement, here are 5 tips to help you get started.
- Conduct a literature scan to find out if researchers in your field are talking about quality measurement. Use search terms like quality measures/metrics/measurement, evidence-based practice, and value-based reimbursement.
- Search the CMS Measures Inventory Tool (CMIT) to see what measures have been developed or are in development for your members’ areas of expertise.
- Add “quality initiatives” to your member survey to find out if proving the value of the healthcare services your members provide is keeping them up at night.
- Search other healthcare associations or medical specialty society websites to find out if any of their quality initiatives may need the expertise of your members—great collaborations begin with a single inquiry.
- Check out the Council for Medical Specialty Societies and find out what other healthcare associations are talking about.
Katherine Ast, MSW LCSW, is the director of Quality and Research for the American Academy of Hospice and Palliative Medicine (AAHPM).
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