ACP offers internists a voice in crafting performance standards

Performance measurement has become a buzzword in health care, even more so since the advent of health care reform. Those who pay for care, especially large employers and government agencies, have increasingly demanded that physicians and others measure care quality and make those results publicly available. Physicians' compensation is now more likely to be based at least in part on measured performance rather than on fee-for-service, and in some cases financial penalties can be levied for not meeting performance benchmarks. But not all programs that use performance measures to determine care quality, and physicians' payment, are well designed.

In 2004, the American College of Physicians formed the Performance Measurement Committee (PMC) to represent its member physicians in national measurement programs and to ensure that nationally endorsed performance measures are based on high-quality evidence. This article is the first in a series intended to keep ACP members informed of the changing performance measurement landscape.

The PMC develops ACP's policies on performance measurement; reviews public performance measures and policies developed by key national organizations; educates ACP members on performance measure issues and activities; and represents ACP on national committees that shape the policies.

The PMC's nine physician members are experts on topics including performance measure development, health informatics, clinical coding, performance measure policies, and research. They work in private practice, academic centers, hospitals, large health care systems, a multi-stakeholder collaborative, and nursing homes.

To date, the PMC has developed three performance measurement policies, on electronic health record criteria; identifying and grading the evidence base for performance measures by developers, national endorsement organizations, and public reporting organizations; and how various performance measures can be used to improve health care delivery.

The PMC reviews performance measures endorsed by national organizations such as the National Committee for Quality Assurance, among others, working to prevent the use of non-evidence-based measures in pay-for-performance and pay-for-reporting programs. During PMC review, performance measures are thoroughly assessed on the following criteria:

1. 1. importance (identification of a gap in care),
2. 2. scientific acceptability (available scientific evidence or clinical guidelines),
3. 3. usability (how beneficial for decision making), and
4. 4. feasibility (burden to implement).

If a measure doesn't meet one of the criteria, the PMC provides formal feedback to the developer. If the feedback is not incorporated into the measures or an appropriate explanation is not offered, ACP votes against national endorsement.

But ACP's vote is one of over 400 organizational votes. A wide range of organizations vote for national endorsement, such as medical specialty societies, health systems, health plans, universities, employers, consumers, and public and community health care agencies, to name a few.

Because ACP has only one vote at the endorsement stage, the PMC also works at the development stage through such programs as the CMS Physician Quality Reporting System (PQRS, formerly PQRI) and the Office of the National Coordinator (ONC) Meaningful Use Program, and through policy review.

The PMC is eager to have ACP members volunteer for committee service or as a representative on other national performance measurement committees. We welcome your thoughts and suggestions about how ACP can improve performance measurement and make it serve the needs of the profession, practicing physicians and the public. Please send suggestions or inquiries to Lea Anne Gardner or Eric Schneider, FACP.