Rising costs and variation in quality are driving efforts to reform healthcare. Performance measurement is an important tool to address cost and quality with widespread support among policy makers. A growing number of hospital quality measures impact the practice and reimbursement of emergency medicine. In addition to current CMS quality measures for community acquired pneumonia (CAP) and acute myocardial infarction (AMI), new CMS quality measures will impact emergency medicine in areas such as stroke, chest pain, imaging, pain management, transitional care, and emergency department (ED) throughput.

Evidence is lacking to support the effectiveness of public policy interventions based on performance measurement, such as public reporting of data and pay for performance. To succeed, emergency clinicians need to understand and practice in alignment with national performance measures. Quality And Performance Measurement: A Guide For Emergency Physicians reviews the origin and evolution of performance measurement, explains the current landscape of reporting, and discusses projections for future hospital quality measure implementation through 2014.

Excerpt from Quality And Performance Measurement: A Guide For Emergency Physicians:

Case Presentation: A 75-year-old man presents to the ED from home complaining of chest pain and shortness of breath. On examination, he is awake and alert, in mild distress, but chest-pain-free. His temperature is 37.8°C (100.1°F), his oxygen saturation is 94% on room air, and his other vital signs and physical examination are unremarkable. An ECG reveals normal sinus rhythm with 1-mm STsegment depressions in leads V4-V6. A portable chest x-ray shows retrocardiac opacity that could be atelectasis or an infiltrate. Labs reveal a troponin of 0.4 ng/mL. The patient is given a 325-mg dose of aspirin by mouth, and IV heparin is initiated. He is then admitted to an inpatient telemetry bed with a primary diagnosis of NSTEMI. On hospital day 2, the patient spiked a fever, and a repeat chest x-ray revealed a lobar pneumonia. One month later, the emergency physician who cared for this patient receives a memo from the hospital’s director of quality, explaining that the patient’s principle discharge diagnosis was community-acquired pneumonia, and as a result, the provider missed several of the pneumonia quality measures. Additionally, the admission was the second inpatient hospital admission for pneumonia within 30 days – a readmission. The emergency physician is asked to sign a letter of acknowledgement after reviewing the case, stating that his care will reflect negatively on the hospital’s publicly reported quality data. Furthermore, he is aware that such “misses” are components of his annual bonus pay.

Introduction: This case is familiar to practicing emergency clinicians and most are aware of the hospital quality measures that apply to AMI and CAP. Many current measures used by the Centers for Medicare and Medicaid Services (CMS) and the Joint Commission would apply to this case. In addition, pending measures including time from arrival to electrocardiogram (ECG), ED length-of-stay (LOS), and pneumonia 30-day mortality and 30-day readmission will apply to this patient. The growing number of performance measures and their widening scope and inclusion in commercial and federal payment programs makes knowledge of performance measures critical to the practicing emergency clinician. In this article, we review the rationale for measuring quality, describe how measures are developed and implemented, detail the current performance measures that apply to emergency medicine, and discuss the effects that the 2010 healthcare reform legislation will have on quality measurement.

With Quality And Performance Measurement: A Guide For Emergency Physicians, you'll receive information on:

• The personal risk to individual physicians from performance measures that don't take into account the particular circumstances of the ED


• The potential misunderstandings with public reporting of outcomes data


• The unintended impacts of hospital-wide measures on the ED: How teamwork can improve patient care


• How quality and performance measurements are developed and influence the quality of emergency care


• What the evidence has to say about the effectiveness of performance measurement


• The future of performance measurement
• 4 AMA PRA Category 1 Credits ^TM at no extra charge.

Quality And Performance Measurement: A Guide For Emergency Physicians -- written by quality measure experts Dr. Christopher Baugh and Dr. Jeremiah Schuur at Brigham and Women's Hospital -- is the only resource to provide clear, concise, and detailed information on hospital quality measures all in one place.

About the Authors:

Christopher W. Baugh, MD, MBA
Department of Emergency Medicine, Brigham and Women’s Hospital; Department of Medicine (Emergency), Harvard Medical School, Boston, MA

Jeremiah D. Schuur, MD, MHS
Department of Emergency Medicine, Brigham and Women’s Hospital; Department of Medicine (Emergency), Harvard Medical School, Boston, MA

Number of CME credits: 4 AMA PRA Category 1 Credits^TM