Arguing that the vast — and constantly growing — number of quality measures that providers are required to track “limits their overall effectiveness,” the Institute of Medicine yesterday proposed a more streamlined approach for assessing performance.


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“If we want to know how effective and efficient our health expenditures are in order to improve health and lower costs, we need to measure the most crucial health outcomes to guide our choices and gauge impact,” David Blumenthal, M.D., president of the Commonwealth Fund, stated. Blumenthal chaired the IOM committee that developed the recommendations. “The proposed core set focuses on the most powerful measures that have the greatest potential to positively affect the health and well-being of Americans.”

The committee noted that the Centers for Medicare & Medicaid Services “measure inventory catalogs nearly 1,700 measures, and the National Quality Forum’s measure database includes 630 measures.” With the continued push toward value- and outcomes-based payment models, the IOM’s recommendations — detailed in Vital Signs: Core Metrics for Health and Health Care Progress — are grouped around a broad set of goals:

  • Life expectancy
  • Well-being
  • Overweight and obesity
  • Addictive behavior
  • Unintended pregnancy
  • Healthy communities
  • Preventive services
  • Care access
  • Patient safety
  • Evidence-based care
  • Care match with patient goals
  • Personal spending burden
  • Population spending burden
  • Individual engagement
  • Community engagement

The committee issued a set of 39 additional measures that can be used to “act as surrogates” while the industry adjusts to this streamlined approach. The IOM also rattled off a number of steps that policymakers and payers could take to adopt these changes.

Creating a more predictable measurement system is something that hospital leaders have been advocating for a while. In a video interview earlier this year, American Hospital Association Chairman Jonathan Perlin, M.D., said that it is not particularly efficient to have multiple measures targeting the “same intent.” That creates undue burden on providers without commensurate benefit, he said. Additionally, as hospitals continue to take on more risk, Perlin said that they need predictability in how they’ll be measured.

In a statement, NQF President and CEO Christine Cassel, M.D., applauded the IOM report, calling it the “latest evidence of an intensifying national effort to better leverage quality measurement to drive health care improvement.” During a keynote address at the American College of Healthcare Executives’ 2015 Congress, Cassel said that the migration to value-based pay demands that “we get the measures right … and get rid of measures that don’t work.”