The NQF Board of Directors has voted to stick to its decision to endorse a new all-cause hospital-wide readmissions measure developed by Yale University and the Centers for Medicare and Medicaid Services (CMS) – a measure challenged by seven hospital systems.

The board voted on June 25 and made the outcome public on June 29.

Known as Measure # 1789, it is used to estimate the hospital-level, risk-standardized rate of unplanned, all-cause readmissions for any eligible condition within 30 days of hospital discharge for patients aged 18 and older. The measure will result in a single summary risk-adjusted readmission rate for conditions or procedures that fall under five specialties: surgery/gynecology, general medicine, cardiorespiratory, cardiovascular and neurology.

The hospital systems that appealed the measure through NQF’s official appeal process, pointed out that the stakes are high for them, as organizations that will be required to publicly report on this measure, and may eventually be paid based on results.

“With respect to the measure itself, the appellants have expressed a view that this measure is "not ready for prime time,” NQF officials said in a statement. “Unintended consequences of measurement have been raised as the major concern relating to the use of measure #1789; more plainly, there is worry that patients may be harmed if access to the hospital is impeded as a result of using this measure.”

During its deliberations, the board reaffirmed the differences between the measure endorsement process, which thoroughly vets the properties of a measure, and that of the Measure Applications Partnership (MAP) whose role is to advise both public and private sectors on best use of measures in payment and public reporting programs.

The board asked MAP to convene a special session over the summer to consider the complex issue of how to use this new measure as part of a broader set of care coordination measures applicable to all types of providers.

CMS agreed to defer use of this particular readmission measure in the new CMS Readmissions Reduction Program until MAP had deliberated and recommended back to CMS its advice on the measure’s optimal use. CMS also reaffirmed its previous commitment to provide findings of the dry run back to NQF’s expert steering committee that reviewed and voted to endorse the measure within one year.

The board also weighed concerns raised about how to approach the issue of achieving consensus, as part of NQF’s Consensus Development Process, when there appears to be a split in NQF’s membership. Membership voting is one step of the consensus development process. The Board proposed seating a task force to explore any potential modifications to NQF’s consensus process, and the task force was approved. Frank Opelka, MD, vice chancellor for clinical affairs at Louisiana State University Health Sciences Center, has agreed to chair the new initiative.

“NQF greatly appreciates and takes to heart the comments and concerns raised throughout this project, both about the potential use of this new measure and how consensus was achieved,” said Janet Corrigan, CEO and president of NQF. “We put great faith in our members and multi-stakeholder, expert committees to help us make decisions that are in the best interests of achieving a higher-value, safer healthcare system. This current project shows that reaching consensus is difficult, but any process that balances multi-stakeholder interests yields important results.” 

Almost one in five Medicare beneficiaries that leave a hospital are readmitted within 30 days, at a cost of approximately $15 billion annually, NQF officials note. And that’s only a portion of patients that experience readmissions. More on NQF's Readmissions Projects can be found here.