The HCAHPS surveys ask discharged inpatients about their hospital experience, including items relating to communication with nurses and doctors, responsiveness of hospital staff, cleanliness and quietness of hospital environment, pain management, communication about medicines and discharge information, and overall rating of hospital and recommendation of hospital. The HCAHPS survey touches on every aspect of the patient’s care including emergency care. For example, one of the HCAHPS questions is: “During this hospital stay, how often did doctors explain things in a way you could understand?” The options for the patient to select are never, sometimes, usually, or always. The survey only reports the percentage of patient responses that report always, and therefore each and every member of the health care team is integral to HCAHPS performance.

While the emergency medicine community has focused efforts on other payment reform initiatives, the Hospital Inpatient VBP Program may have received less attention. Yet ED leaders may soon experience heightened pressure from hospital administrators to achieve high performance and/or improve scores on these measures.

National Quality Forum

Historically, the final common pathway for quality measure endorsement has been approval by a voluntary consensus standards-setting organization, which CMS has deemed necessary for inclusion into the IPPS and OPPS programs. The NQF has become the de facto quality measure endorsement organization. In addition, CMS contracts with the NQF to identify and vet certain measure sets. Table 5 lists the NQF-endorsed ED-relevant measures (that are not current CMS quality measures) in both Phase 1 and Phase 2 of the Voluntary Consensus Standards for Ambulatory Care. In the future, CMS may choose to incorporate some of these NQF-endorsed measures into their IPPS, OPPS, or PQRS programs.

The NQF issued a call for candidate measures in July 2011 under the Endorsing Resource Use Standards project. The research and education foundation of the American Board of Medical Specialties (ABMS-REF) and the Brookings Institution, working under a grant from the Robert Wood Johnson Foundation, recently developed 22 separate measure specifications spanning 12 high-impact conditions; 18 of the 22 measures were submitted. ACEP members contributed to this project known as the High Value Health Care Project: Characterizing Episodes and Costs of Care (C3). A controversial aspect of this project included attribution of the cost of the care at the individual physician level. As of September 2011, these measures were withdrawn from NQF review until further field testing could be performed. Two other organizations, Ingenix and the National Committee for Quality Assurance (NCQA), still have resource use measures under consideration.