Glossary

Terms Used When Discussing Quality Measures

Measures

Measure: A mechanism to assign a quantity to an attribute by comparison to a criterion.

Clinical performance measure: A subtype of quality measure that is a mechanism for assessing the degree to which a provider competently and safely delivers clinical services that are appropriate for the patient in the optimal time period.

Evidence-based measures: Measures developed from evidence-based clinical guidelines, using standard evidence-based processes. Evidence-based measures are generally considered to be the most sound. All ACR quality indicators are developed using evidence-based clinical guidelines.

Quality measure: A mechanism to assign a quantity to quality of care by comparison to a criterion.

Quality performance indicator: Agreed upon process or outcome measure used to assess quality of care.

Desirable attributes of a quality measure: The National Quality Measures Clearinghouse conducted a comprehensive review of existing frameworks of desirable attributes of quality measures from national and international organizations committed to measuring and improving quality. They identified three desirable attributes of a quality measure. These three areas are (1) the importance of a measure, (2) the scientific soundness of a measure, and (3) the feasibility of a measure. The ACR considers all three areas when developing quality measures for rheumatology, in addition to clinical relevance.

Pay-for Performance (P4P)

Pay-for-performance: P4P provides financial incentives to those providers who demonstrate they perform practices that are associated with providing quality of care.

Value-based purchasing: Another term for P4P.

Other Terms

Medicare Economic Index: a measure of the cost of providing medical care. The MEI values a “market basket” of inputs to the price of healthcare (salaries, equipment, services, etc) to assess annual changes in the price of healthcare. The MEI is used, in conjunction with the Sustainable Growth Rate formula to update Medicare physician fee schedules.

Medicare Payment Advisory Commission: an independent federal advisory body established by the Balanced Budget Act of 1997 to advise the U.S. Congress on issues affecting Medicare. Among other things, MedPAC advises Congress on payments to private health plans and healthcare providers caring for Medicare beneficiaries.

Sustainable Growth Rate: Federal law requires Medicare payments to physicians to be modified annually using a formula known as the sustainable growth rate. The formula to calculate the SGR is based on four factors: the estimated percentage change in fees for physicians’ services; the estimated change in the number of Medicare fee-for-service beneficiaries; the estimated average 10-year annual in real gross domestic product per capita; the estimated change in expenditures due to change in laws or regulations. Under the SGR formula, fees to Medicare providers are cut whenever the volume of services to Medicare beneficiaries exceeds a set level. Short-term congressional fixes have averted cuts to the SGR in recent years.