MAP offers HHS recommendations on quality reporting programs

WASHINGTON – The Measure Applications Partnership (MAP) has issued two new reports to the Department of Health and Human Services, presenting quality measurement strategies for hospitals that specialize in cancer care and for hospice and palliative care providers.

MAP is a multi-stakeholder public-private group convened in 2011 by the National Quality Forum (NQF) to provide guidance on measures for use in public reporting, performance-based payment and other performance measurement programs. These two reports are the latest in a series of several quality measurement coordination strategies authored by the group, officials say.

The recommendations in both areas are spurred by new legal requirements. With regard to hospice and palliative care, the Patient Protection and Affordable Care Act (ACA) creates the Medicare Hospice Quality Measurement Program, which requires hospice programs to publicly report quality data beginning in 2014 or incur a financial penalty. Hospice care is a Medicare benefit in the last six months of life.

Likewise, the ACA stipulates that 11 hospitals that specialize in cancer care, called PPS-Exempt Cancer Hospitals, must begin to publicly report quality data in 2014, although with no financial penalty or incentive attached to the reporting activity. These specialty cancer hospitals have been exempt from the Medicare Prospective Payment System (PPS) because their narrow focus on cancer care does not lend itself to the payment program as designed. As a result, they have not been required to participate in federal quality reporting programs that now apply to most other hospitals.

"These measurement strategies are geared toward improving the care of patients grappling with serious and complex healthcare issues," says Elizabeth McGlynn, co-chair of the MAP coordinating committee. "The new public reporting programs, and MAP's reports, are part of a broader effort to ensure that measurement-driven quality improvement and accountability are being applied across the spectrum of the healthcare system."

Both new reports emphasize the importance of measuring components of care that patients and their families find meaningful. This includes surveying patients about their experiences of care, assessing quality of life, evaluating pain and symptom management, and tracking whether each patient has a care plan that signals their preferences, is kept updated, and is being honored. Patients seeking hospice care at the end of life, for example, often choose to avoid unwanted medical procedures and trips to the hospital. Targeted measures can and should assess these dimensions of care, MAP recommends.

The reports also emphasize the importance of measuring how well patients transition from one care setting or type of provider to another – for example, from a hospital to a nursing home or care provided in their own homes. Such "hand-offs" occur frequently for cancer and seriously ill patients and often expose patients and their families to fragmented care from providers who are not communicating – at all or well – with each other. In both new reports, MAP emphasizes that performance measures should evaluate patients' full experiences as they move through the healthcare system, as treatment received in one setting may impact the course of treatment received in another.

"These reports represent an important step toward ensuring that patients who are seriously or terminally ill receive care that addresses all their needs and is being carefully evaluated through standardized measurement programs," says Carol Raphael, chair of the MAP post-acute care/long-term care workgroup.

In each new report, MAP identifies a "core set" of specific quality measures it believes can be applied immediately or quickly adopted to care at PPS-exempt cancer hospitals or to hospice and palliative care services. In addition, the group notes significant areas where no or few measures exist, signaling opportunities for the measure development community to step in to fill important gaps.

In its recommendations for cancer care, for example, MAP stresses the importance of survival data to patients' decision-making on both treatments and providers. It advises that survival data presented to patients and families include information on the specific type and stage of cancer.

"Clear and comparable information on survival rates can be critical to cancer patients and their families making very tough choices at an emotional time," says Frank Opelka, MD, chair of the MAP Hospital Workgroup.

In its report on hospice and palliative care services, MAP notes that many who qualify for the Medicare hospice care benefit either fail to make use of it or do so for a shorter period than the Medicare benefit allows. As a result, MAP advises measuring the degree to which patients have access to, and are well informed about, the alternatives of hospice and palliative care.

"Consistent with its past work, MAP's new reports further expand our thinking about what's important to measure and improve in healthcare in addition to the actual clinical outcomes of care," says George Isham, MD, co-chair of the MAP coordinating committee. "We need to be especially vigilant about how fully and well informed patients are as they move through a complex system, especially if they have life-threatening illnesses or are terminally ill."

The full Performance Measurement Coordination Strategy for PPS-Exempt Cancer Hospitals and Performance Measurement Coordination Strategy for Hospice and Palliative Care reports are available here.