National Organizations and Initiatives

Agency for Healthcare Research and Quality (AHRQ) / National Quality Measures Clearinghouse (NQMC)

Searchable compendium of performance measures from many domains of healthcare, including mental health.

The Joint Commission (HBIPS)

The Joint Commission has specified “core measures” for hospital-based inpatient psychiatric services. Until 2008, psychiatric hospitals had reported on self-selected measures. Introducing a core measure set for accreditation provides data that can be used at a national level of analysis to identify problem areas, demonstrate quality improvement, and identify other trends. The topics of the measures are: assessment of violence, risk, substance abuse, trauma and patient strengths completed; hours of restraint use; hours of seclusion use; patients discharged on multiple antipsychotic medications [emphasis is documenting adequate clinical rationale for polypharmacy]; and discharge assessment and aftercare recommendations created and provided to community health providers upon discharge. Presently, free-standing psychiatric hospitals are required to utilize the HBIPS measure set, while general medical/surgical hospitals with inpatient psychiatric units are not.

The APA has been in a partnership with the Joint Commission, National Association of Psychiatric Health Systems (NAPHS), National Association of State Mental Health Program Directors (NASMHPD), and the NASMHPD Research, Inc. to develop the “core measures.” The HBIPS measure set, submitted to the NQF for consideration, received endorsement on 6 of the 7 measures. HBIPS-1 (Admission Screening) has yet to receive endorsement.

Physician Consortium for Performance Improvement (PCPI)

Convened by the American Medical Association (AMA). The Consortium includes physician and methodologist representatives from a variety of healthcare stakeholders. PCPI engages physicians to develop physician-level, evidence-based, condition-centered clinical performance measures and outcomes reporting tools. As one of the 6 largest physician organizations, APA has a seat on the Executive Committee of the PCPI, formerly held by John Oldham, M.D., and now, currently held by Jack McIntyre, M.D.

APA was involved in the development of the adult MDD measure set, the adolescent/child MDD measure set, the substance use disorder measure set and the dementia measure set.

Center for Quality Assessment and Improvement in Mental Health (CQAIMH)

The Center for Quality Assessment and Improvement in Mental Health (CQAIMH) conducts mental health services research and provides quality management services to improve community-based care for individuals with mental health and addictions disorders. Consisting of faculty and staff from the Institute for Clinical Research & Health Policy Studies at Tufts-New England Medical Center, Tufts University School of Medicine and Harvard University, CQAIMH develops methods of quality assessment, studies organizational determinants of quality, and tests strategies for quality improvement.

NCQA/Healthcare Effectiveness Data and Information Set (HEDIS)

Health-plan level measures include several mental health measures.

The National Quality Forum (NQF)

The mission of the NQF is to improve American healthcare through endorsement of consensus-based national standards for measurement and public reporting of healthcare performance data that provide meaningful information about whether care is safe, timely, beneficial, patient-centered, equitable and efficient. The NQF supports the National Priorities Partnership to set the national performance measure agenda. NQF is recognized by Congress, which requires that measures used in federal programs are NQF endorsed.

APA is a voting member of NQF through APIRE (American Psychiatric Institute for Research and Education). While a set of ambulatory measures, including measures on MDD, ADHD, Bipolar Disorder, and SUD were endorsed by NQF in December 2006, mental health measure endorsement is ongoing. A selection of mental health measures endorsed by NQF can be accessed here. Several APA members serve on NQF Technical Advisory Panels and Steering Committees.

National Priority Partners (NPP)

Sets national priorities and goals for the Department of Health and Human Services National Quality Strategy. The 48 member stake-holder organizations also play a key role in identifying strategies for achieving the aims of better care, affordable care, and healthy people and communities; and facilitating coordinated, multi-stakeholder action. Current efforts are not condition specific, but do address issues that mental health providers are confronted with:

AQA formerly Ambulatory Care Quality Alliance

The AQA is an alliance of physician organizations, consumers, insurance plans, payers and government agencies whose mission is to come to a consensus on a common national strategy for physician-level performance measurement, data aggregation and performance reporting. Its primary focus is the implementation of performance measures. APA has been a member of AQA since fall 2005.

Bridges to Excellence

Coordinates several pay for performance initiatives. This includes the Depression Care Program promoted by MN Community Measurement (more below).

HealthcareCommunities.org

Healthcare Communities is a web-based knowledge management system that provides multiple means for the healthcare quality improvement community to share knowledge and contribute to each other’s QI work. This includes material on mental health.

Centers for Medicare & Medicaid Services (CMS)

The PQRS is a voluntary, physician-level performance reporting program of CMS. The program currently includes 3 measures on major depressive disorder and 1 measure on screening for unhealthy alcohol use. Participants in this program have the opportunity to receive various incentive amounts based on their Medicare claims. More on PQRS and information for psychiatrists can be found on the APA PQRS page.

Additional CMS programs of interest to APA members:

Physician Compare

The Physician Compare Website serves as a healthcare professional directory on Medicare.gov. The Physician Compare Web site includes information about physicians and other professionals who participated in the Physician Quality Reporting System (PQRS) and those who participated in the Electronic Prescribing (eRx) Incentive Program. CMS is currently working to implement a plan for making information on individual physician performance publicly available through Physician Compare by January 1, 2013.

Additionally, CMS has created the Quality Care Finder as a collection of helpful tools on the Medicare.gov website to help consumers research their healthcare options. These online research tools can help Medicare patients and their caregivers compare healthcare providers, facilities, health and drug plans, equipment suppliers and more.

Minnesota HealthScoresSM

A web-based rating program built on data provided by Minnesota health plans as well as data submitted directly by more than 300 medical clinics statewide. It is promoted by MN Community Measurement to accelerate the improvement of health by publicly reporting health care information. The Depression Care Program is based on the DIAMOND collaborative care project in Minnesota, this care program uses the PHQ-9 tool, a nine-item depression scale questionnaire aimed at helping primary care physicians and behavioral specialists diagnose, select and monitor treatment.