Officials at the Centers for Medicare and Medicaid Services recently released an initial set of pediatric quality measures that states can choose to use as part of their Medicaid and State Children's Health Insurance Programs.
The set of 24 measures focuses on prevention and health promotion, immunizations, screening, well-child visits, management of acute and chronic conditions, family experiences with care, and access to services. For example, one of the measures calls for annual hemoglobin A1c testing in all children and adolescents who are diagnosed with diabetes.
The measures may be familiar to pediatricians, as 14 of the 24 are current NCQA Healthcare Effectiveness Data and Information Set (HEDIS) measures reported by Medicaid managed care plans. They are part of an effort to encourage quality reporting within Medicaid and SCHIP, but they will be voluntary and the requirements of the program would be up to individual states to determine. The new measures program was established as part of the Children's Health Insurance Program Reauthorization Act of 2009, which required the federal government to identify a core set of child health quality measures for voluntary use by state programs. The government's charge was to identify existing measures used by public and private health plans. The initial measure set was developed in consultation with child health care providers, according to the CMS.
The CMS sought public comments on which measures should remain part of the core set, which measures need further development, and what type of technical assistance physicians and other providers would need to report on these measures. Comments were due by March 1. Under statute, the CMS must make the final measure set available to states by Jan. 1, 2013. Currently, there is no federal funding set aside as financial incentives for successfully reporting on these measures, but the CMS and the states are exploring ways they could encourage voluntary reporting, such as provider incentive payments provided under the American Recovery and Reinvestment Act, according to the CMS.
The move to develop pediatric-specific quality measures was praised by the American Academy of Pediatrics. The organization was involved in the creation of the initial measure set, and encouraged Congress to invest in the development of measures appropriate for children. That's definitely an area in which pediatrics has fallen behind, said Dr. Stuart A. Cohen, a pediatrician in San Diego and an AAP delegate to the American Medical Association. Right now, pediatric quality measures are mostly built off measures from adult medicine, he said.
There is also a lack of research into what measures would have the greatest impact on quality. Dr. Cohen said that current measurement in pediatrics focuses on areas like immunizations and antibiotic usage, but it's not clear on whether those are the best measures of high-quality pediatric care. He speculated that future research could begin with outcomes of care and work backward to determine what kind of care was given. “We don't have those measures,” he said.
Although details about how the measurement program would be set up by the states are still to come, Dr. Cohen said he would like to see an appeals process to ensure that physicians have the opportunity to dispute inaccurate data, a safeguard that is in place in most private pay-for-performance programs.
CMS officials are working to coordinate the measurement program with health information technology activities at the state and federal levels. Under the CHIP Reauthorization Act that created the quality measures program, the CMS was also tasked with developing a pediatric electronic health record format. CMS officials are working to coordinate that effort—as well as the meaningful-use criteria for EHRs—with the quality-measurement program.
A list of each measure and summaries of why they are being recommended are available at www.ahrq.gov/chip/corebackgrnd.htm