Reaching top quality of care a joint effort

In an earlier column, I shared with you my perspective on quality-of-care issues as they related to the everyday practicing physician. This quality-of-care methodology has traditionally followed us and became an integral part of who we are from the first day of medical school through residency training and into our daily activities as we cared for our patients.

Quality of care is a key strategic issue for the American Medical Association as well. The efforts of physicians associated with specialty and state societies to work together in what now is known as the "quality" arena is more recent.

In 2000, in recognition of physicians' professional responsibility to provide quality health care, the AMA brought together specialty and state society physicians interested in and committed to quality and performance measurement. From those roots came the Physician Consortium for Performance Improvement. In November 2000, the consortium was created by merging the Performance Measures Advisory Committee, the Specialty Advisory Committee and the three committees originally established and convened by the AMA to provide advice on the current and evolving science of physician performance measurement and outcomes of care.

From that early and visionary effort, the consortium has grown in size, stature and significance. Today membership includes more than 100 national medical specialty societies, state medical societies, medical specialty boards, federal agencies and various health care organizations that share common visions, concerns and a commitment to creating physician-developed performance measures. These measures provide evidence-based metrics that can be used to measure performance, plan needed improvements and then measure again to document their success.

The vigor of the consortium represents a renewed dedication voiced by representatives of member medical specialty societies to coordinate medicine's activities in performance measurement and quality improvement. As the consortium has matured, the need for a more defined overall governance structure became evident.

In March 2006, the consortium proposed and approved a new structure that I believe will continue to enhance the role of our profession. The Consortium Executive Committee was expanded to include representatives from the AMA, the Council of Medical Specialty Societies and the six largest national medical specialty societies as well as others from within the consortium membership. It bears noting that membership in the consortium is open to those committed to health care quality improvement and patient safety. Members participate in the development, review, dissemination or implementation of performance measures and measurement resources.

So why should physicians be interested in the background, structure and processes of the consortium? That is a legitimate question. The consortium and the measures it develops are important for physicians and patients. Once conceived, with attention to evidence and deliberation across specialty lines, the measures are voted on by the consortium, and, if approved, released for use by physicians and others (such as continuing medical education providers and private and public payers) toward the goal of improving patient care.

There is an old adage that states "you cannot improve what you do not measure." The consortium provides our profession performance measures developed through a consensus process with methodological expertise and broad input from -- and review by -- multiple specialties and the public. It avoids measures developed in isolation and creates an atmosphere of professional confidence and support.

Once measures are developed, they are forwarded to the National Quality Forum to be considered for endorsement and to the Ambulatory Care Quality Alliance to be considered for selection. Significantly, the Centers for Medicare & Medicaid Services looks to the NQF and ACQA to endorse the measures that will be used in their measurement programs. In fact, 59 of the 74 measurements in the 2007 CMS Physician Quality Reporting Initiative were developed by the consortium.

Also, measures are being implemented by medical specialties supported by education from CME providers. This process of bringing the profession together to promote quality at an even higher and more organized level is moving forward, and the consortium will continue to be a key leader in its evolution.

The consortium develops nationally recognized physician-level performance measures that can be used to promote improvements in quality of care. The consortium has provided the medical community a visible mechanism to demonstrate to those outside our medical world the profession's commitment to improvement in patient care.

The consortium serves as a credible forum, one recognized by policymakers and quality stakeholders, where multiple medical specialties meet to develop evidence-based clinical performance measures that aim to enhance the quality of patient care. I have no hesitation in saying that the consortium serves medicine and our patients very well.