Our synthesis of existing measures and the most frequent and costly services/procedures (based on S codes) performed in the HOPS revealed that there are a few publicly available existing measures to address these services/procedures. Topics addressed by existing measures include cataract extraction, indications for cardiac catheterization, colonoscopy, MRI complications, and treatment for cardiac arrhythmias. However, there are many services/procedures for which there are no existing measures. In addition, existing measures that focus on diagnostic and therapeutic services/procedures are concerned primarily with whether or not the service/procedure was provided, not the quality with which it was performed. For example, performance measures on Papanicolaou [Pap] smear relate to the physician obtaining the smear, not the screening of the smear by the cytotechnologist and cytopathologist; mammography measures relate to the frequency and indications for the procedure rather than the whether appropriate and adequate views were obtained or the completeness of the radiologists assessment of the mammography. Identifying the providing specialty is especially of interest given that quality of patient care is optimized when the requesting and providing specialties work together; frequently the providing specialty knows best how to obtain the optimal results from the services provided.
Some specialty organizations have developed measures to provide guidance to physicians from other specialties who order their services. For example, the AGAI, which represents gastroenterologists, worked with the PCPI and NCQA to develop physician-level measures for colorectal cancer screening and GERD that are applicable to primary care physicians also.
The above discussion should not be taken to mean that expectations for the quality with which services are delivered, which are relevant to performing specialties, do not exist for some conditions. For example, radiologists and radiology facilities offering mammography services must comply with the Mammography Quality Standards Act (MQSA) of 1992. Additionally, pathologists, other laboratory professionals, and clinical laboratories must comply with the Clinical Laboratory Improvement Amendments (CLIA) regulations, including Section 493.855(a) that relates to cytology proficiency testing (CLIA 88). Furthermore, the AMA’S PCPI has developed physician-level measures for surgery related to the timing of antibiotic administration and venous thromboembolism prophylaxis. Some of these measures are applicable to outpatient surgeries.