At the request of the Department of Health and Human Services (HHS), the Measure Applications Partnership (MAP) has issued two new reports that present quality measurement strategies for a group of hospitals that specialize in cancer care and for the nation’s growing number of hospice and palliative care providers. The recommendations in both areas are sparked by new requirements in law. In the case of 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.
Similarly, 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.
MAP is a public-private, multi-stakeholder group convened by the National Quality Forum (NQF) in 2011 to provide guidance on measures for use in public reporting, performance-based payment, and other performance measurement programs. The two reports are the latest in a series of several quality measurement coordination strategies authored by the group (http://bit.ly/wMljPc).
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 stress 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 transitions, or “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.