Why do quality and performance measures matter?


By Oliver J. Wisco, DO

There is an increased focus on quality and performance measurement in health care. Why is this important and how is the AAD responding to the trend?


First, what is a performance measure? We find performance measures in three areas: Research (typically referred to as scientific questions), improvement, and accountability. The latter two areas of measurement are found in clinical practice and fall within the field of improvement science.

Within the Affordable Care Act (ACA), improvement and accountability measures are a primary focus of the new payment models proposed. An improvement measure is a standard, a basis for comparison, and a reference point against which other things can be evaluated. It can involve both objective/quantitative and subjective/qualitative aspects. Measurement arises from the axiom that you can’t understand, manage, or improve what you can’t measure.

Collecting measures in dermatology practice not only demonstrates value and quality, but also protects long-term interests while advancing dermatology.

Process and outcome measures are the two main types of improvement and accountability measures. Process measurement captures care process components that should be performed to enable the best care.

Outcome measures evaluate how successfully interventions have met certain goals. The development and use of outcome measures is the ultimate goal in medicine: To use them to show the true value of care delivery.


The goals of improvement measures are guided by the “triple aim” approach:

  • The improvement of the patient care experience, including quality and satisfaction.
  • The improvement of population health.
  • Reduction of the per capita cost of health care.

Medicare has established a system of quality measure reporting that ties incentives and penalties to participation. On one hand, these measures gather evidence about cost control, value for government dollars, and quality of services, as well as efficiency and accountability. On the other hand, these same measures are leveraging tools specialties use to demonstrate to payers the quality and value of medical services and procedures performed.

Performance measures are typically designed by widely represented stakeholder workgroups that identify critical, actionable prerequisites for specific clinical outcomes and ways of capturing the associated performance indicators. These measures are submitted for approval to a non-partisan entity that vets them through a rigorous process to ensure they are reliable and valid. This entity is called the National Quality Forum (NQF).

Increased demand

Given the increasing demand for performance measures, the Academy is working proactively to ensure that dermatology has a say in the formulation of measures by which the performance of dermatologists is assessed.

The Academy has a Performance Measurement Task Force (PMTF) that identifies where value and quality in dermatology can be demonstrated. The PMTF is also responsible for identifying potential challenges within the specialty (e.g.: over-utilization) and devising fair and feasible measures to reduce waste.

The task force and its work groups ensure that the interests of dermatologists and their patients are protected and that the measures align with the Academy’s strategic framework and vision. Collecting measures in dermatology practice not only demonstrates value and quality, but also protects long-term interests while advancing dermatology.

Dr. Wisco is the dermatology clinic chief at 81st Medical Group-Keesler Air Force Base (AFB), Biloxi, Miss. He also is the chair of the AAD's Performance Measurement Task Force.

Email the Member to Member editor at members@aad.org.

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