We mapped the clinical measures identified through our measures scan to the most common diagnoses and conditions treated, services/procedures, and drugs/biologicals provided in the HOPS, as identified in the data analysis described above. In the mappings of measures to diagnoses and conditions, we used subcategories of the diagnostic groupings to better match reasons for visits to topics relevant to metric development. For example, within endocrinology, we separately identified the common diagnoses of diabetes and thyroid disease – clinical conditions with sufficient specificity that measures could be matched to these diagnoses.
In conducting our work, we note several limitations which CMS could consider addressing in subsequent work to develop performance measures in the outpatient hospital setting:
- We elected to focus on the HOPS (as opposed to the ED) for this measures mapping exercise because the majority of existing measures correspond to conditions and diagnoses that most commonly occur in the HOPS, rather than the ED. We acknowledge that some conditions and services/procedures occur more frequently in the ED setting; therefore a separate synthesis focusing on mapping measures to the care provided in the ED merits consideration for future analyses.
- The mapping of measures to common diagnoses and clinical conditions focused on encounters that involved only E&M care for acute and chronic conditions.
We recognize that other encounters are specifically for a service/procedure (e.g., mammography), and many encounters involve both E&M care and services/procedure(s). Given that multiple APCs are frequently submitted for an encounter, future analyses examining data at the patient encounter level would provide a better understanding of services provided at that level.
We then combined the results from the mapping exercise described above with the findings from our discussions to identify measurement gaps. Gaps refer to clinical areas or other domains of care where care was delivered but few or no measures exist or areas flagged by discussants as having a lack of existing measures. The gap analysis was organized by the six IOM aims viewed as important in the provision of high-quality care (IOM, 2001). This gap analysis considered both the HOPS and the ED.