In 2005, the Center for Medicare and Medicaid Services (CMS) approached several medical specialty societies to begin sponsoring quality measure development for inclusion in Medicare's Physician Quality Reporting System, formerly known as the Physician Quality Reporting Initiative (PQRI).
The Physician Quality Reporting System is currently a voluntary program that began in 2007 as a part of the pay-for-performance movement. This program offers an incentive bonus to physicians who perform and report quality measures; however bonuses will decrease over the next several years. Penalties for non-participation will begin in 2015.
The National Quality Forum (NQF) is a voluntary consensus standards body that reviews and endorses quality measures. CMS prefers to use NQF sponsored measures, but the Physician Quality Reporting Initiative is not limited only to NQF-endorsed measures.
Measure development process
The American Academy of Dermatology is committed to ensuring dermatologists are able to participate in the Physician Quality Reporting System. As such, the AAD is active in the process to develop and secure approval of measure relevant to the practice of dermatology. The measure development process is as follows:
1. Selection of topics: The AAD’s Performance Measurement Task Force creates a list of topics for measure development based on gaps in care. Gaps in care are identified issues and/or problem areas where specific steps in quality care have been missed or performed incorrectly. Once gaps in care are identified, the source of the problem also needs to be identified, as well as an appropriate corrective action.
2. Subgroup assignments for development of measures: Quality measure subgroups are created by the task force chair based on the proposed quality measure topics and their prioritization. Subgroups are developed as members of the task force volunteer to work on quality measure development. If the task force is collaborating with the American Medical Association’s Physician Consortium for Performance Improvement on development of a quality measure, the consortium’s measure development process would be introduced at this juncture.
3. Review process: Quality measure subgroups present the independently constructed measures to the task force. All members of the task force then have an opportunity to submit comments and suggestions on how to improve the measure prior to submission.
4. Literature and guideline support: AAD staff identifies current guidelines, accepted by the National Guidelines Clearinghouse, to support the developed measures. Literature searches are conducted by staff to identify data in support of each quality measure. Such data need to illustrate that the quality measure identifies a high aspect of care, an opportunity for improvement, and also needs to include contradictory evidence. All evidence is provided to subgroup members for support of the measures.
5. Final approval by task force: Fully developed measures, including measure specifications and all supporting evidence, are circulated amongst the task force. All task force members are allowed final comments and suggestions on the measures. Comments and suggestions are incorporated at the discretion of the chair.
6. Measure submitted to National Quality Forum (NQF) during a call for measures: The National Quality Forum releases a call for measures, based on a specific subject area. If the task force has developed measures that are relevant to the call, these measures are submitted to NQF for possible endorsement.
NQF-endorsed quality measures
In October 2009, NQF endorsed two melanoma measures that the American Academy of Dermatology developed in conjunction with the AMA's Physician Consortium for Performance Improvement (PCPI) for time-limited endorsement. Time-limited endorsement is a temporary endorsement, during which the AAD has time to collect, measure and provide testing data focused on inter-rater reliability. In May 2010, NQF endorsed two other measures reviewed as a part of the NQF’s Coordination Practices and Measures Project.
Current NQF-endorsed measures are:
- Melanoma Coordination of Care: Percentage of patients seen with a new occurrence of melanoma who have a treatment plan documented in the chart that was communicated to the physician(s) providing continuing care within one month of diagnosis.
- Melanoma: Appropriate Use of Imaging Studies: Percentage of patients with stage 0 or IA melanoma, without signs or symptoms, for whom no diagnostic imaging studies were ordered.
These measures are being reviewed as a part of NQF's Care:
- Melanoma Recall: Patients entered into a recall system with the target date for the next complete physical skin exam specified, at least once within the 12-month reporting period.
- Biopsy Follow-Up: Percentage of patients who are undergoing a biopsy whose biopsy results have been reviewed by the biopsying physician and communicated to the primary care physician and the patient, denoted by entering said physicians initials into a log, as well as by documentation in the patient chart.
Future measure development
Measures currently under consideration by the AAD’s Performance Measurement Task force are:
- Atopic dermatitis
- Psoriasis and psoriatic arthritis
- STD screening
- Surgical time-out
- Gluco-corticoid-induced osteoporosis
Performance Measurement Task Force members
- Dirk M. Elston, MD, chair
- Kent Aftergut, MD
- An-Wen Chan, MD, PhD
- Lisa H. Lerner, MD
- Todd Schlesinger, MD
- Arthur J. Sober, MD
- Janet Sullivan, MD
- Oliver Wisco, DO
- Melissa A. Reyes Merin, MD, resident
- Sarah Schram, MD, resident