Just when you finished your performance dashboard, it looks like the performance measurement set is going to change. Last month, the National Quality Forum’s (NQF) Measure Applications Partnership (MAP) recommended that the federal government remove 51 health care quality measures from the 240 sets used in federal health care value-based purchasing, public reporting, and other programs (see NQF Recommends Updated Quality Measures For HHS). This includes seven measures specifically related to behavioral health.
If you’re unfamiliar with it, the MAP is a partnership between 90 private-sector organizations and seven federal agencies that recommends measures for private sector payers and advises the U.S. Department of Health and Human Services (HHS) on the selection of performance measures for federal health programs and payers (see NQF & DHHS Quality Measures: Setting Standards For Patient Outcomes In Medicare).
Of the behavioral health measures, I thought the proposed changes to measures specific to inpatient mental health services were most interesting. The report included recommendations for changes to these seven measures from the Inpatient Psychiatric Facility Quality Reporting Program:
- Follow-Up After Hospitalization for Mental Illness (FUH): MAP recommended that this measure be re-specified for acute care and submitted for NQF endorsement.
- Tobacco Use Screening: MAP noted the importance of tobacco cessation but recommended that CMS prioritize measures that will better address the quality of mental health care.
- Tobacco Use Treatment Provided or Offered and the subset measure, Tobacco Use Treatment: MAP noted the importance of tobacco cessation but recommended that CMS prioritize measures that will better address the quality of mental health care.
- Tobacco Use Treatment Provided or Offered at Discharge and the subset measure, Tobacco Use Treatment at Discharge: MAP noted the importance of tobacco cessation but recommended that CMS prioritize measures that will better address the quality of mental health care.
- Alcohol Use Screening: MAP noted the importance of addressing substance abuse but recommended that the Centers for Medicare & Medicaid Services (CMS) prioritize measures that will better address the quality of mental health care.
- Alcohol Use Brief Intervention Provided or Offered and Alcohol Use Brief Intervention: MAP noted the importance of addressing substance abuse but recommended that CMS prioritize measures that will better address the quality of mental health care.
- Alcohol & Other Drug Use Disorder Treatment Provided or Offered at Discharge and Alcohol & Other Drug Use Disorder Treatment at Discharge: MAP noted the importance of addressing substance abuse but recommended that CMS prioritize measures that will better address the quality of mental health care.
It’s important to note that if these changes are recommendations that could be taken up by any organization (most notably HHS). But the rationale for changing these measures includes a notation from MAP that programs should measure outcomes more directly related to the quality of care — and in the case of the examples listed above for behavioral health, inpatient psychiatric care.
Harold Pincus, M.D., professor and vice chair of psychiatry at Columbia University and co-chair of the MAP Coordinating Committee, released this perspective as part of the recommendations, “Getting to measures that matter for improving patient care without creating unnecessary administrative burdens is a balancing act. To get it right, we need more feedback from patients, frontline doctors, and other health care professionals on what works and what needs improvement in health care quality measurement” (see NQF’s Measure Applications Partnership Identifies Opportunities to Reduce Measure Burden in Federal Healthcare Programs).
To help unpack these changes a little, I reached out to OPEN MINDS Advisory Board Member and Grafton Integrated Health Network Chief Executive Officer Jamie Stewart. He writes:
Follow up on discharge from inpatient psych stay seems an interesting removal since for other services recidivism within 30 days causes a payback penalty. I find it interesting they do not feel some measurement is appropriate for psych stays but that may say more about how disconnected the outpatient system in behavioral health is from the inpatient system and that the stay cannot be aligned with community-based services.
The other seven all have to do with some form of substance use (if we consider tobacco a substance). First, I find it interesting that the NQF had chosen these things as a needed follow-up related to the inpatient psych stay to begin with. Unless the patient was presenting because of the substance use or it was a contributing cause it would seem to not be a factor in that acute stay need and more of a long-term health need. But, again, what I find more interesting is no mention of items to address post discharge from a community-based service model and how that should stabilize a patient and diminish further inpatient stays for psych needs.
Maybe the better question to ask for behavioral health is does anyone on the 90 NQF agencies really understand behavioral health and how it is run, versus an academic perspective of behavioral health. I am pretty sure if asked community mental health centers (CMHC) leaders could come up with quality standards that would have somewhat broad support.
Having said all that, I do agree that they should look for ways to “measure outcomes more directly related to the quality of the inpatient care.”
It sounds to me like they are trying to segment the mental health service population. From this wording “that inpatient follow-up care measures need a wording change to distinguish an acute care discharge from a long-term placement discharge” they are saying that SMI and the persistently mentally ill need a separate set of standards from someone identified as more acute mental health needs. I am not sure if I like this or not.
At first glance I like that maybe SMI and those served consistently are being recognized as different. I think our outcomes and expectations for them should be different because they do need a different level of community-based support that our CMHC’s should deliver. But, I do fear the SMI could get lost in the shuffle if the attention goes only to truly acute inpatient stays.
For more on linking your performance to your finances, join me on September 27 for the session, “Preparing Specialty Provider Organizations For Value-Based Reimbursement: An Overview Of Competencies Required For Success,” featuring OPEN MINDS Senior Associate Joe Naughton-Travers at The 2017 OPEN MINDS Executive Leadership Retreat in Gettysburg, Pennsylvania.