IOM: New agency needed to simplify pay-for-performance measures

The Institute of Medicine says consolidation of quality benchmarks under one roof will be necessary for value-based purchasing and would be easier on doctors.

By David Glendinning, amednews staff. Dec. 19, 2005.

Washington -- The physicians and researchers tasked by lawmakers to help get pay-for-performance off the ground worry that it's already carrying too much weight for liftoff.

The Institute of Medicine released a report earlier this month detailing a plan to adopt and develop performance measures, the building blocks for any program that bases payments for services on quality of care. While researchers concluded that several good sets of measures already exist, they noted that they are too numerous and spread out to be effective.

"Currently, it's a little bit like the Tower of Babel. There's a set of uncoordinated requests to measure and capture different things in different formats," said Steven Schroeder, MD, a health professor at the University of California in San Francisco and chair of the IOM committee that produced the report. "If they were streamlined and coordinated, it actually might ease the regulatory burden on overworked physicians."

The group's proposed solution to this roadblock is to establish a new federal office within the Dept. of Health and Human Services that would coordinate and fund the development of quality measures needed for pay-for-performance, public reporting, accreditation or any other quality improvement effort.

The National Quality Coordination Board would set the benchmarks that government initiatives -- and potentially private-sector ones as well -- would utilize.

Placing all of these efforts under one roof would minimize the burden on physicians and others to keep track of multiple lists of quality measures that have little to do with one another, said Alan Nelson, MD, a member of the IOM committee. A more cogent set of reporting guidelines shared by Medicare, Medicaid, private insurers and review boards would make doctors' lives a lot easier as more payers start to link reimbursements to quality, he said.

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