Quality Measurement: Time To Get Serious: APhA-APRS

Abstract

Quality has always been important to pharmacists. As health professionals, pharmacists strive to provide safe and appropriate care to their patients. The systematic measurement of quality in health care, however, is a relatively recent phenomenon. Over the past two decades, hospitals, managed care organizations, and long-term care facilities have been required to develop measures of quality and report performance data to accrediting bodies and governmental regulators. Many of the quality measures in these facilities pertain to the safe and appropriate use of medications. The demand for qualityrelated information has been driven by private purchasers of health services, such as employers, as well as state and federal regulators such the Centers for Medicare and Medicaid Services (CMS). These demands have been facilitated through accrediting bodies, such as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the National Committee for Quality Assurance (NCQA), which have increasingly based their accreditation decisions on quality indicators. More recently, CMS and other payers have begun shifting toward a pay-for-performance framework, wherein physicians and hospitals will receive reimbursement based on explicit measures of quality. Community pharmacy has largely been immune to the increasing requirements for quality measurement and reporting, but this has begun to change. Numerous state legislatures have created requirements for pharmacies to implement quality assurance or quality improvement programs. While few states have attempted to require community pharmacies to publicly report quality-related events (e.g., medication errors), attention to the safety and quality of pharmacy services has increased. I believe that the most significant driver of quality measurement in community pharmacy for the future will be the federal government via CMS. With the advent of the Medicare Part D benefit, CMS has become very interested in the quality of medication use. Recently, CMS facilitated the creation of the Pharmacy Quality Alliance (PQA), which is charged with developing methods to measure and report the quality of pharmacy services. Before describing the activities of PQA, I first explore some basics on quality measurement.