Another group of quality measures that may soon affect emergency medicine reimbursement involves the new Episode of Care (EOC) prototype. Recent passage of the Patient Protection and Affordable Care Act (ACA) legislation in 2010 includes methods to develop and test novel models of health care delivery and payment reform. The goals are to reduce costs by eliminating waste and to improve patient health outcomes by aligning provider and hospital incentives. The proposed reforms are based on a “value-based purchasing” paradigm, rather than the current fee-for-service payment system, which reimburses providers and institutions based on the volume of services provided. The mandated development of global payment systems reimburses both hospitals and providers for the complete management of a patient over a defined period of time.

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. Eighteen 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 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 As of September 2011, these measures were withdrawn from NQF review until further field testing could be performed.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 NCQA, still have resource use measures under consideration.

Last, NQF is in the early stages of developing palliative care and regionalized emergency care measures. A group spearheaded by the University of North Carolina developed a white paper on regionalized emergency care for the NQF. Comments from ACEP were submitted in August 2011 during the solicitation period. A steering committee for palliative and end-of-life care gathered at the end of July 2011 to discuss a set of 12 new measures that may affect emergency medicine.

Conclusion

Quality measures continue to exert considerable influence on the practice and reimbursement of emergency care. While provider-based measures mainly focus on the clinical care of specific medical conditions, the overwhelming share of upcoming hospital-based measures address emergency department throughput, timeliness of care, and imaging utilization issues. The passage of Episodes of Care measures constructed on a value-based purchasing and bundled payment paradigm may be imminent.