Performance Measurement in the Hospital Outpatient Setting. Next Steps for Consideration


Due to the limited resources for this project, the work completed here should be viewed as a preliminary assessment that requires follow-on work to fully flesh out how to apply existing performance measures in this setting and where the most important measurement gaps are for guiding the use of resources in the future.

As measurement efforts in the outpatient setting move forward, CMS could consider expanding on the work of this evaluation by

  1. Conducting additional analyses of the OPPS data: Additional analyses using more detailed and complete OPPS data could refine the set of conditions, services/procedures, and drugs/biologicals that were identified in this study. This analysis could also include a broad set of clinical experts to help evaluate the care provided in the hospital outpatient setting to determine what the priorities should be for performance measurement and whether and how to group services and procedures for measurement. The analyses could address the limitations and suggested modifications noted in this study.
  2. Conducting a detailed mapping of measures to key areas of use and costs: Once more in-depth data analysis has occurred, a detailed mapping exercise between content areas and existing measures could determine measures that are ready to be used without modifications, and those that require modification and how they could be modified for use to assess performance at the hospital outpatient facility level. Once this work is completed, the candidate measures could be submitted to NQF for their review and endorsement.
  3. Determining where additional gaps exist and establish priorities for filling gaps: The information gathered from the in-depth data analyses and detailed measures mapping exercise could be used to identify gaps in measures. This review could consider the prioritization of conditions, services/procedures, and drugs/biologicals for determining future measures development work.

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