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Physicians pioneering quality improvement

Improving the quality of health care is a critically important challenge facing our nation's health care system. A number of health care quality issues (including serious gaps and disparities in care) and the steady increase in health care costs have led to an intensified demand for ways to measure and improve the quality of care provided by physicians.

Through the Physician Consortium for Performance Improvement® (PCPI), organized medicine is proactively responding to those demands. Convened by the AMA, PCPI takes the lead in the development, testing, and maintenance of evidence-based clinical performance measures and measurement resources for physicians.

PCPI brings together the expertise of physicians representing a vast range of specialties and several government agencies, (PDF, 27KB) including more than 100 national medical specialty and state medical societies; the Council of Medical Specialty Societies; the American Board of Medical Specialties and its member boards; experts in methodology and data collection; the Agency for Healthcare Research and Quality; and the Centers for Medicare & Medicaid Services (CMS).

In Chicago last week, PCPI members approved 12 more performance measures. That brings the total number of approved measures to 206, addressing 29 clinical topics. Another 34 measures are currently in development.

These evidence-based measures, which are multi-disciplinary in scope and reflect the realities of everyday medicine, allow physicians to systematically review data on the care they provide—and thereby identify areas for quality improvement. They’re accepted by physicians throughout the profession, as well as other quality measurement organizations. The National Quality Forum (NQF) has endorsed 63 of PCPI’s performance measures, and the AQA alliance recognizes 89 measures.

Of the 74 performance measures used by CMS's Physician Quality Reporting Initiative (PQRI), 59 were developed by PCPI, or by PCPI in conjunction with the National Committee for Quality Assurance (NCQA) and medical specialty societies. This is significant in that congressional leaders have said that if physicians don’t show leadership in developing measures and helping to improve physician performance, the federal government will fill the void. Prior to the PQRI, CMS pilot-tested several PCPI measures in national projects, including the Doctors Office Quality (DOQ) and DOQ-Information Technology (DOQ-IT) projects.

PCPI also provides performance measure definitions and specifications for implementing its measures using multiple data sources, including paper medical records, administrative (claims) data using CPT® Category II codes, and with particular emphasis on electronic health records (EHR) systems.

The AMA is working to achieve functionality among EHR systems to query and report performance measures. To that end, the AMA and the NCQA, working together as the Collaborative for Performance Measure Integration with EHR System (PDF, 36KB), have developed "best practices" recommendations for measure developers, EHR vendors, and physician practices. They’ve also established and are testing an EHR-vendor requested format for transmitting performance measure definitions and specifications to EHR systems vendors that, together, will help facilitate the incorporation of PCPI and NCQA measures into EHR systems.

Another example of an implementation effort using PCPI measures is Cardio-HIT, a research collaborative involving five EHR system-enabled independent group practices that have been collecting data and reporting on nationally recognized physician performance measures for coronary artery disease and heart failure.

Physicians might be asked to participate in many different quality improvement programs, perhaps by a medical society, a physician group practice, a hospital medical staff, or a public or private payer, so it's essential that these programs include measures that are accurate, fair, and evidence based. Embracing PCPI's performance measures is a big step toward that goal.

Ask your program administrators or EHR vendors if they're using the measures developed by PCPI. If they aren't, please ask why. By working together, we can lead the way in improving the quality of care afforded to our patients.


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