REPORT OF THE BOARD OF TRUSTEES
B of T Report 20 – A-05
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Subject:
Physician Consortium for Performance Improvement
Presented by:
J. James Rohack, MD, Chair
At the request of the American Medical Association (AMA) Board of Trustees Task Force on
Quality, Safety, and EHR, this report, which is being provided to the House of Delegates for its
information and involvement, provides an update on the AMA-convened Physician Consortium
for Performance Improvement.
Membership, Mission, and Vision
The Physician Consortium for Performance Improvement (the Consortium), which established its
name, mission, and vision in November 2000, identifies and develops performance measurement
resources to assist physicians in enhancing the quality of care. As of March 2005, the
Consortium included more than 65 national medical specialty societies; eight state medical
associations; experts in methodology and data collection; the Agency for Healthcare Research
and Quality (AHRQ); and the Centers for Medicare and Medicaid Services (CMS). The Joint
Commission on Accreditation of Healthcare Organizations and the National Committee for
Quality Assurance (NCQA) are liaison members of the Consortium. The Consortium is convened
and staffed by the AMA, which also provides independent consultants to support the Consortium.
The vision of the Consortium, a physician-led initiative, is to fulfill the responsibility of
physicians to patient care and public health and safety by: 1) becoming the leading source
organization for evidence-based performance measures and outcomes reporting tools for
physicians; and 2) ensuring that all components of the medical profession have a leadership role
in all national forums seeking to evaluate the quality of patient care. The mission of the
Consortium is to improve patient health and safety by identifying and developing evidence-based
clinical performance measures that enhance quality of patient care and that foster accountability;
promoting the implementation of effective and relevant clinical performance improvement
activities; and advancing the science of clinical performance measurement and improvement.
Clinical Performance Measures
As of March 2005, the Consortium had completed clinical performance measurement sets
intended for practicing physicians for the following conditions and preventive care and screening
topics:
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Adult diabetes;1
Asthma;
Chronic obstructive pulmonary disease;
Community-acquired bacterial pneumonia;
Coronary artery disease;2
Heart failure;2
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Hypertension;2
Major depressive disorder;
Osteoarthritis of the knee;3
Prenatal testing;
Preventive Care and Screening Measures:
--Colorectal cancer screening,
--Influenza immunization, adult,
--Screening mammography,
--Problem drinking, and
--Tobacco use cessation.
The Consortium plans to develop measures for the following topics in 2005:
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Atrial fibrillation,2
Child and adolescent major depressive disorder,
Pediatric gastroenteritis,4 and
Peri-operative care.5
1
Developed by the National Diabetes Quality Improvement Alliance
Developed in collaboration with the American College of Cardiology and the American Heart Association
3
Developed in collaboration with the American Academy of Orthopaedic Surgeons
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To be developed in collaboration with the American Academy of Pediatrics and the American Academy of Family Physicians
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To be developed in collaboration with the American College of Surgeons, the National Surgical Quality Improvement Program, and
the Veterans Administration
2
In addition, the Consortium will conduct reviews of several existing measurement sets in 2005 to
ensure they remain current with clinical recommendations and the results of measure testing.
Any Consortium member or interested party may submit a topic to the Consortium for possible
measure development. The Consortium also considers topics of interest to national groups,
including AHRQ, CMS, the National Quality Forum, and the Institute of Medicine. Suggested
topics are reviewed against a set of established criteria and voted on by the full Consortium.
National medical specialty societies may serve as “lead organizations” with the Consortium in
developing measurement sets. As of March 2005, the following societies have served, or will
serve, as lead organizations:
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American Academy of Orthopaedic Surgeons,
American College of Cardiology,
American Heart Association,
American Academy of Pediatrics, and
American Academy of Family Physicians.
The Consortium is in active discussions with the following societies regarding measurement
development or review of existing measures:
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American Academy of Otolaryngology-Head and Neck Surgery,
American Society of Clinical Oncology,
American Association of Clinical Endocrinologists,
American Academy of Neurology,
Renal Physicians Association, and
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American Academy of Ophthalmology.
Process and Hallmarks of Consortium Performance Measure Development
When a topic is selected for measure development, the Consortium convenes a Work Group that
includes volunteers from the Consortium membership, additional clinicians and medical
professionals knowledgeable of the topic, and representatives from the patient, employer, and
health plan communities. Following Consortium and public comment periods, the Work Group
seeks consensus in making a recommendation to the full Consortium. The Consortium makes the
final determination by vote as to whether the set should be approved for widespread distribution
for testing and use.
Regardless of the topic of the measures, several Consortium hallmarks apply:
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the measures are based on evidence provided in clinical practice guidelines,
the Work Groups include cross-specialty representation,
the Work Groups solicit comments from the Consortium and the public,
the measurement sets and data collection vehicles may serve as both measurement tools and
interventions, and
the measures are relevant for clinical practice by considering medical and patient reasons why
a guideline recommendation may not be followed.
Maintaining the Integrity of Consortium Work
The AMA holds copyright on the performance measures on behalf of the Consortium, which is an
unincorporated entity. The copyright enables the Consortium to: (a) protect the uniformity and
integrity of the measures; (b) update its measures as necessary; and (c) retire or withdraw
outdated measures—a patient safety issue.
Consortium members and others can use the measures for any noncommercial purpose; e.g., use
by health care providers in connection with their practices is not a commercial use. Commercial
use is defined as the sale, license, or distribution of measures for commercial gain, or
incorporation of the measures into a product or service that is sold, licensed, or distributed for
commercial gain. The Consortium has authorized the AMA, on behalf of the Consortium, to
negotiate license agreements as appropriate, for commercial uses of the measures to promote their
implementation. The AMA has developed a royalty-free licensing agreement template for use of
the measures by vendors of electronic health records.
Use of Consortium Measures
The Consortium measures are intended to assist physicians in enhancing the quality of care.
Measures are designed for use by any physician who manages the care of a patient for a specific
condition or for prevention. The measures are not clinical guidelines and do not establish a
standard of medical care. The Consortium has not tested its measures for all potential
applications but encourages the testing and evaluation of its measures for multiple purposes,
including point-of-care information for patient management; aggregate patient data for systems
analysis; continuing medical education credit; components of maintenance of certification for
board certification; health plan and payor requests for data; and pay-for-performance programs.
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National Recognition of Consortium Work
In late 2002, CMS requested that the Consortium develop performance measures for testing in its
Doctors’ Office Quality and Doctors’ Office Quality-Information Technology pilot projects.
CMS covered the costs to develop the measures, which were completed in early 2003, for
coronary artery disease, heart failure, hypertension, osteoarthritis, and major depressive disorder.
Also at the request of CMS, in 2004/2005 the Consortium developed performance measures for
chronic obstructive pulmonary disease; these measures will be tested in the CMS Chronic Care
Improvement Project (CCIP). Additionally, David Brailer, MD, PhD, the National Coordinator
for Health Information Technology, released a framework for strategic action in July 2004 that
called for streamlining quality and health status monitoring and noted the use of Consortium
measures in CMS pilot projects as part of this strategy.
The National Quality Forum (NQF) has initiated an ambulatory care performance measure
project. Phase II of the project includes an expedited review of measures submitted jointly by
CMS, the AMA/Consortium, and NCQA. The NQF board is expecting to vote on the measures
in July, following recommendations from technical committees and member comments. The
AMA has entered an agreement with NQF, on behalf of the Consortium, to maintain the
Consortium measures endorsed by NQF.
Additionally, America’s Health Insurance Plans, the American College of Physicians, American
Academy of Family Physicians, and AHRQ have formed a group charged with identifying a
“starter set” of measures that can be used by health plans in pay-for-performance programs.
Participants in the initial meetings expressed interest in considering Consortium and NCQA
measures for inclusion in its starter set.
Integration of Consortium Measures into Health Information Technology
The AMA is working with three different practice sites in the Chicago area to test the ability to
enter data and retrieve reports from electronic health systems based on the specifications for the
Consortium’s measures. This work is partially funded by two AHRQ grants.
B of T Report 20 – A-05 – page 5