The Studies of August

At the very time we’re tempted to sneak a snooze in the hammock a last time or two, we’ve been jarred from our late-August stupor by a traffic jam of reports emanating from a variety of government bodies. Oblivious to the rites of season, studies like these cycle through the landscape on their own unrelenting schedules, providing essential lubrication for the thrust and parry of health policy.

From the bounty of the last few days, here’s three reports of particular note:

    • One key riddle at the heart of the health reform law is the essential benefits package. The law gives special responsibilities in this area to IOM, which, as part of its charge, has now published a workshop report on essential benefits. If you read nothing else: Check out Chapter 5, where Alan Garber takes on medical necessity and use of evidence.

Finally, as if to remind us that the rhythms of research are indeed unceasing, the Patient-Centered Outcomes Research Institute has requested proposals from vendors willing to provide recommendations on a topic that seems pivotal to the Institute’s mission: a working definition of “patient-centered outcomes research.”

We’ll look forward, in a future post, to reporting how this PCORI project turns out. But for now, the hammock beckons.

CMS, GAO Underscore Ebb and Flow of Quality Measures

That development and use of quality measures can be an excruciatingly gradual process marked by policy ebbs and flows was pointed up by two items that came across the transom of our research platform last week.

On the one hand, quality-measure proponents might see forward momentum in CMS’ request for comments on development of a new, more comprehensive measure of hospital readmissions. Before now, much of the agency’s attention had been directed to readmission measures targeted to discrete areas, such as COPD and vascular procedures. But a Yale New Haven draft methodology report for a new all-condition readmission measure sweeps in a much broader group of procedures (check out Table 1). Comments are due August 29, and CMS seeks feedback in areas like inclusion and exclusion criteria; organization of cohorts; and choice of covariates for risk adjustment.

In contrast, the second item serves as a reminder that actually implementing quality measures can be a hard slog. In a report on the Medicare physician feedback program, GAO noted difficulties in using quality measures in a way that is “meaningful, actionable, and reliable.” The report says additional steps — such as more physician input on the “usefulness and credibility” of individual measures — are needed before a workable value-based payment system can be put in place.

Alas, quality measures, like much else in life, may require taking at least one step back for every two steps forward.