Developing Quality Measures in Otolaryngology-Head and Neck Surgery

Everybody defines quality differently, and the biggest challenge we have is to make sure the focus stays on the patient, said Dr. Nielsen.

To this end, organizations such as AAO-HNS are looking at ways to develop metrics within their own specialties that reflect appropriate and accurate performance measures. Not only will this proactive approach help keep the focus on the patient, but it will also defend against external measures of quality being used to, for example, pay or not pay physicians based on purely administrative or financial performance.

For physicians who are not yet convinced that they need to address issues of quality and even participate in developing metrics in their own practices, the need to get on board is coming from stipulations already in place by organizations, such as health plans and Medicare, who are demanding demonstrations of quality for payment.

Further incentive is coming from the need for physicians to now demonstrate their participation in quality improvement to maintain board certification, as well as renewal of state licensure.

All these demands are pushing physicians into the quality movement. According to Dr. Nielsen, it is up to organizations like the AAO-HNS to respond to these demands and help provide measures for its members. We want to be at the forefront to make sure these demands are relevant, valid, patient-centered, and not just being made up by someone who wants to make a buck off the system, he said.

What the Academy is Doing

In an attempt to get otolaryngologists and head and neck surgeons involved in developing and using performance measures, the AAO-HNS is urging members to review and critique measures pertaining to their specialties utilized by a number of organizations (see sidebar, page 13).

The main help we ask of our members is to review measures being developed by other organizations that may affect the field of otolaryngology, said Jenissa Haidari, MPH, Senior Program Manager for Quality Improvement for the AAO-HNS.

From the AAO-HNS perspective, performance measures should be focused on the following:

• Improving quality of care and safety.
• Relevance to medical and health outcomes.
• Based on data that is fully risk-adjusted.
• Based on fair and accurate models for attributing care.
• Allowing physicians to review and correct performance data.

One program that the AAO-HNS has urged physicians to get involved in is the Physician Quality Reporting Initiative (PQRI). Initiated by the Centers for Medicare and Medicaid Services (CMS), this national program provides bonus pay for physicians who report using performance measures related to otolaryngology. (A complete list and details of PQRI performance measures related to otolaryngology can be found at www.entnet.org .)