Accountability Measures:
The Joint Commission’s New
Approach to Performance
Measurement
Mark R. Chassin, MD, FACP, MPP, MPH
President, The Joint Commission
Audioconference
June 30, 2010

The Changing Environment for
Quality Measurement

Medicare and TJC programs now call only for reporting of quality measures

No incentives for specified performance

New programs will change this status quo
• CMS: “incentive payments” in FY 2013
• Funding for new measures, outcomes
• Network selection in private sector
• Measures for new delivery forms

Rapid Improvement
 In 2000, few measures, no national data collection or reporting
• No real-world experience
• Resistance among hospitals
 Today---all that has changed
 In a very short time, hospitals have made major progress toward establishing consistent excellence

Improving Measurement
 A great deal of real-world experience
• Many measures work well; some don’t
• Must replace measures that don’t work

No formal process to assess that experience, learn from it, and act on it
 TJC working with all stakeholders
 Defining new quality measurement approach to maximize health outcomes

A Model That Works
TJC hospitals have improved markedly on core measures in use since 2002; several are at high levels of consistent excellence
Acute MI: 2009 Hospital Performance
US avg(%) % > 90%
Aspirin on arrival 98 98
BB on discharge 98 97
Joint Commission Annual Report 2010

A Model That Works
More recent measures are catching up.
Surgical measures: first full year was 2005
Antibiotic prophylaxis in surgery:
2009 Hospital Performance
US avg(%) % > 90%
First dose w/in 1h 96 91
Stopped w/in 24h 93 79
Joint Commission Annual Report 2010

Measures With Clinical Integrity:
“Accountability Measures”

Examples: Aspirin, beta blockers, and ACE inhibitors for acute MI; surgical antibiotic prophylaxis; new perinatal measures

Characteristics of Accountability Measures
• Large volume of research proves relationship to improved outcomes
• Process is closely connected to outcome
• Measure accurately assesses process
• No or minimal unintended adverse effects

Non-Accountability Measures

Smoking cessation counseling (3)

Heart failure discharge instructions

Oxygenation

LV function assessment

First dose of antibiotic in 6 hrs (pneumonia)

Pregnancy measures (old)

Accountability Measures and
Opportunities Over Time

Number of accountability measures and performance have increased over time

2002: 8 accountability measures
• Overall performance = 81.8%
• # opportunities = 957,000

2009: 22 accountability measures
• Overall performance = 95.4%
• # opportunities = 12.5 million

100
90
80
70
60
50
40
30
20
10
0
Hospital Performance on
Accountability Core Measures
2002 2003 2004 2005 2006 2007 2008 2009

The Future is Now
 New direction for TJC to help hospitals get ready for new uses of measures:
1) Press to eliminate bad measures
2) Include performance on accountability measures in accreditation standards
3) Include only accountability measures in ORYX program
4) Help hospitals improve performance on accountability measures

Accreditation Standards
 How to incorporate performance on accountability measures into standards?
• Will not be surveyed on site
• Level of performance, # measures
• What time period?
• How should we expect hospitals to respond to an RFI?

We seek extensive input from hospitals

Accountability Measures and
TJC Programs

Aim to include in ORYX only measures that meet all 4 accountability tests

Existing non-CMS core measure sets are under evaluation (perinatal, HBIPS, stroke)

Quality Check: only accountability measures count in overall rate for each measure set

S3, PFP: non-accountability measures weighted at 0.33 (vs. 1.0 for accountability)

Helping Hospitals Improve
 Most hospitals’ performance on accountability measures is excellent:
86% of hospitals > 90% on all of them

TJC to provide the evidence that improved core measure performance leads to improved patient outcomes
 TJC creating “solutions exchange” to facilitate sharing effective interventions