The effort comes at a key time: CMS is moving ahead at full steam to require more use of alternate payment models in reimbursement.
The National Quality Forum (NQF) now has a Disparities Standing Committee, which seeks to use quality measurement to reduce and eventually eliminate the differences in the ways groups experience healthcare. The 22-member panel features academics expert, clinicians, health system executives, payers, advocates, and other stakeholders.
The co-chairs are Marshall Chin, MD, MPH, of the University of Chicago, and Ninez Perez, MPP, PhD, of the Fielding School of Public Health and Center of Health Policy Research at the University of California, Los Angeles.
Disparities present a challenging issue in healthcare, because increasingly reimbursement will be tied to how well providers fare on such measures. Doctors and hospitals that treat higher numbers of poor patients ask whether it is fair to penalize them if they deliver good care but still see bad outcomes, given higher comorbidity rates, poverty, language barriers, and education gaps. At the same time, no one wants to see low-income areas “settle” for a lesser standard of care.
NQF has spent several years addressing the question of how to deal with disparities in healthcare measurement. In 2012, NQF’s board of directors endorsed 12 quality measures that focused on healthcare disparities and cultural competency, and more recently NQF began a 2-year trial period in which socioeconomic status will be taken into account when computing performance measures. A chief task of the Disparities Standing Committee (DSC) will be to examine the results of the trial period, to help NQF decide if the policy change should remain.
Helen Burstin, MD, MPH, chief scientific officer at NQF, told The American Journal of Managed Care in an interview that the standing committee allows the organization to move beyond handling the disparities question through a series of one-time projects; now, these questions will be integrated in all NQF’s work.
The first step, Burstin said, “is to develop a road map,” for how to create measures that will, in time, eliminate disparities in healthcare. Only when it’s fully understood how disparities affect measurement, and how to account for them when assessing quality, can good measures be used to push the policy levers to reward those providers who aren’t just moving through a checklist, but trying to make real changes.
“When we are building this into pay-for-performance, it’s essential that disparities is not the afterthought that it tends to be, but is part of the core measurement strategy.”
So often when one reads a scientific study, the overall findings say one thing, but the results by race or socioeconomic group say something else. For example, the recent announcement from CDC that the number of new diabetes cases seems to be dropping is good news—but mostly for well-educated whites. The disease remains a major health problem among African Americans, especially those who are poor and living in certain regions of the country.
Disparities in healthcare are rarely the main story, Burstin said, but with the new committee, “We really want it to be the story itself.”
While socioeconomic disparities get most of the attention, differences also can appear based on race and ethnicity, language or disability, and Burstin said that part of the DSC’s charge will be deciding how to handle these, too.
“This is a longstanding personal passion of mine,” she said. “What will it take to make disparities women into the fabric quality measures?”
Burstin’s enthusiasm is clear, not only for having the committee, but also for the members who have agreed to serve, and for the timing—just as CMS is moving at full steam to make alternate payment models a centerpiece of reimbursement. “It’s important that we not miss some really important changes in approach to payment reform,” she said. “I am so glad this is moving forward now. ... There is a remarkable amount of urgency.”