Because physician-level measurement sets were introduced relatively recently—and some are still in development—they have not yet been widely implemented by report card sponsors. The measure sets listed here have been endorsed, in whole or in part, by the National Quality Forum (NQF), an organization established to standardize healthcare quality and reporting.
The Healthcare Effectiveness Data and Information Set (HEDIS) is a widely used set of performance measures in the managed care industry. Implemented in the early 1990s to measure health plan performance, HEDIS incorporated physician-level measures in 2006. HEDIS is managed by the National Committee for Quality Assurance (NCQA), a private, non-profit organization that accredits and certifies healthcare organizations.
HEDIS measures of physician quality address:
Most of the measures of physician quality are adapted from HEDIS indicators commonly reported at the health plan level. They can be used to assess performance at the individual, practice site, or medical group level. Many of the measures have NQF's endorsement.
The Core Quality Measures Collaborative (CQMC) is a multi-stakeholder coalition of healthcare organizations first convened by America's Health Insurance Plans (AHIP) in 2015. Their goal was to work together to recommend core sets of quality measures by clinical area for use in alternative payment models.
Review the CQMC's eight core sets of quality measures for primary and specialty care.
CAHPS, or the Consumer Assessment of Healthcare Providers and Systems, refers to a set of standardized surveys that can be used to gather and report information on consumers’ experiences with providers and health plans.
The CAHPS Clinician & Group Survey assesses the experiences of patients with physicians and their office staff; specifically, the measures cover:
Questionnaires are available for adults or children receiving primary or specialty care. Optional supplemental items can be used to gather additional information about patients' experiences with care.
Users can field these questionnaires to obtain information on group practices, sites of care, individual clinicians, or provider networks.
Under the Affordable Care Act, the Department of Health and Human Services (HHS) must collect and publish healthcare quality measures for adult and child enrollees in Medicaid. States can collect data for two sets of measures, many of which can be used for physician practices or groups:
Other sources of measures include physician specialty societies (e.g., American College of Surgeons) and disease-focused organizations (e.g., American Diabetes Association). Many of these organizations—too numerous to list here—have created measures addressing clinical quality issues specific to a particular specialty or health condition. Some of these measures may be included in the PCPI initiative described above. Visit the Web sites of each organization for more information.