Performance Measures

in Radiology

Jeffrey Shyu, MD

Performance Measure

Specific, quantifiable indicator of an aspect of healthcare Proportion of patients treated according to a specified standard

Structures, processes, outcomes

Important for healthcare quality assessment

Increasingly important for reimbursement

Donabedian A. 1966; Donabedian A. 1988

Pay for PerformancePhysicians and Groups

Pay for PerformanceFacilities and Institutions

*Hospitals must participate in data collection, submission and public reporting of performance rates in order to receive the

annual payment update on Hospital Outpatient Prospective Payment System (HOPPS) services the following year.

Measure Lifespan

Measures Development

May be designed by anyone: individuals, groups, institutions, or consortia

Most radiology-related measures developed by the ACR Metrics Committee, in collaboration with the AMA-PCPI

Identify areas of need

Review evidence

Construct measure specifications

Conduct public review

ExamplePQRS Measure #195 (NQF 0507)

Stenosis Measurement in Carotid Imaging Reports

Denominator: all finalized carotid imaging study reports Neck MRA, neck CTA, neck duplex ultrasound, carotid

angiography

Numerator: subset of finalized carotid imaging study reports that make direct or indirect reference to measurements of distal internal carotid diameter as the diameter for stenosis measurement To fulfill numerator criteria, measurements must make reference

to established and validated measurement criteria, e.g. NASCET

Measure Testing

Validity: does the measure capture what it intends to capture?

Reliability: do different raters obtain similar numerators and denominators?

Feasibility: is it challenging to implement?

Unintended consequences

AMA-PCPI

NQF Endorsement

Measure may go to the NQF for endorsement

Endorsed measures are considered “gold standard measures

Additional level of analysis, consensus development, and feedback Eight steps

Endorsed measures often end up in pay-for-performance programs Approximately 700 NQF-endorsed

measures

Post-Implementation Testing and

Maintenance

May be designed by individuals, groups, institutions, consortia

May be designed for internal quality improvement efforts or towards more widespread implementation (e.g. requiring NQF endorsement)

NQF measures undergo periodic maintenance and review Ensure relevance and continued best practices

New specifications (e.g. imaging modality) may be added

Harmonization

Measure steward is responsible for submitting updated information

ExamplePQRS Measure #10

Documenting the presence or absence of stroke, hemorrhage, or mass on brain CT and MRI reports

Retired by the NQF at the end of 2012

Lack of evidence supporting whether actual documentation of these findings affected outcomes or would change practice

t-PA often administered long before report finalized

NQF

Radiology-Relevant Measures (PQRS)

Future Steps

Evidence on pay-for-performance has been mixed

Few imaging-related measures assess outcomes e.g., rate of diagnostic errors

Need for more outcomes-oriented measures

Difficult to develop radiology-specific outcomes measures as image performance and interpretation is only one component of a patient’s overall outcome

Ryan AM 2011; Ryan AM 2012; Jha AK 2012; Sutton M 2012