Leaders press for fewer quality measures

February 17, 2014 in Medical Technology

Tom Daschle former Senate majority leader, a Democrat from South Dakota,  and Michael Leavitt, former governor of Utah and Department of Health and Human Services Secretary under George W. Bush, agree the sheer volume of uncoordinated measures is overwhelming clinicians. Until these measures are narrowed down to the most important ones, and made uniform across all sectors of healthcare, the task of improving care will remain elusive, they say.

As opponents politically, at times, Daschle and Leavitt have the same goals in mind for healthcare: the transition to value-based care.

At the annual National Quality Forum conference in Washington, DC on Feb. 14, Daschle, who is now special policy advisor to the law firm of Alston Bird joined Leavitt, now co-leader of the Nutrition and Physical Activity Initiative at the Bipartisan Policy Center, in a panel discussion to contend that the American healthcare system is making terrific headway, but more could be done to spur progress. Namely, the U.S. healthcare market needs to rally around a unified group of measures deemed to be most crucial.

“The dilemma we are having in driving quality measurement is we are still trying to fuss with the little gears,” Leavitt said. “We are going to have to discover the big gears and turn them. That’s all the consumer has interest in dealing with.”

An example of an effective big gear being used to measure healthcare quality today is the focus on readmission days. “As you spin this big gear, you will notice a lot of smaller gears also begin to spin,” he added.

Daschle hailed HITECH and the Affordable Care Act for laying down the important infrastructure for quality healthcare, but measurements are still in a state of chaos, he said. 

In the 15 years since the launch of the NQF, healthcare quality measurement has become more confusing than ever. “It’s the Wild West of today,” he said.

Providers are subjected to too many measures, with some 1367 for performance in use, all largely unaligned. Daschle predicts that as payment reform leans more and more toward value-based care “it could get even worse than it is today,” he warned.

On the same token, the state of chaos also provides an extraordinary opportunity to fix things, Daschle said. He would like to see the NQF become “the gold standard” of measures. Along with that, a dose of tough love and accepting that “you can’t please everyone all the time,” America could make some real headway, he said. “We might not be able to tame the Wild West, but we could bring some urgently needed law and order.”

The two leaders agreed on the big gear theory and the need for taming chaotic measurements, but true to their political outlooks, they also diverged. Daschle was very optimistic about the infrastructure laid down by the Affordable Care Act, with its emphasis on well care.

Leavitt said America shouldn’t be so quick to attribute ACA with changes to the U.S. healthcare system. Improvement is being brought about more by the will of the consumer. The free market is driving change in healthcare.

America’s healthcare crisis is an economic crisis, Leavitt said. And he feels optimistic that that crisis will drive citizens to come up with a uniquely American solution to healthcare. “The economic pressure is driving people to do the hard things,” he said.

[See also: Health IT experts brainstorm with ONC on clinical quality measures.]

As far as ACA goes, “you can implement just about any system in time,” Leavitt said. “We’ve been going through a complicated, labored implementation. But you have to ask the question now, `is it working, and how can we make it better where it’s not working?’”

This will move the U.S. to an entirely different level of reform discussions, Leavitt said. That discussion will focus on refinement, rather than repeal and replace of ACA. 

To borrow from Leavitt’s analogy, Daschle said the ACA is starting to turn the three big gears of insurance, payment, and care delivery reform. The launch of ACA has begun to bring insurance reform. Payment reform, still to come, will center on bundled payments, while care delivery will focus more on wellness care than it ever has before.

[See also: Big data to assess CMS quality measures.]

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