Proliferating standards begin to ease

CMS. HQA. ASHP. Leapfrog Group. NQF. JCAHO. AHQA. VA. AHRQ. The list of regulators, professional associations, government agencies, payers, consumer groups, and others that claim to set standards for health care seems to grow daily. Every new standard, every new information request, every new effort to assess or improve quality adds to the hospital administrative burden.

"There are simply too many standards and too many people trying to set standards," said Kasey Thompson, director of the ASHP Center on Patient Safety. "That has been a problem and continues to be a problem. But there are some bright spots."

The brightest spot, Thompson said, is NQF, the National Quality Forum. Formed in 1999 following a White House Conference on quality in health care, NQF has taken the lead in standardizing healthcare standards. ASHP was one of the original members of NQF.

"As multiple entities requested information, hospitals had a lot more work just satisfying the different requests," said NQF president and CEO Kenneth Kizer, M.D. "The additional burden was significant to substantial, depending on the institution and the entity making the request."

Kizer said NQF has never assessed the hours or dollars that hospitals spend collecting data or adjusting delivery of care to satisfy the different groups clamoring to set the standard of care. The American Hospital Association (AHA) estimated that extracting and collecting medical record data takes 25 to 30 minutes per record.

"Hospitals have longed for commonality in data collection," said Nancy Foster, AHA senior associate director for health policy. "There are still too many different groups trying to get data-states, payers, insurers. They all have good intentions, but using different measures and standards makes life significantly more difficult for everyone."

NQF's answer to proliferating standards was consensus. Bring together as many of the interested parties as possible, including ASHP and AHA, to forge agreement out of chaos. At last count, more than 260 consumer, health provider, health plan, government, purchaser, research, and quality organizations had a seat at the NQF table.

"There is finally some alignment of standards starting to take hold," said Mary Inguanti, VP of operations for St. Francis Hospital and Medical Center in Hartford. "AHA is getting more closely aligned with CMS and JCAHO. Traditionally, all of these bodies looked at quality and benchmarking differently enough that you had to collect the same data multiple times. Quality outcomes is the common goal, but this is like trying to turn the Queen Mary around. You can do it, but not quickly."

Consensus is both NQF's primary strength and its most obvious weakness. Since starting deliberations in 2001, the national body has come up with 65 standards for inpatient care.

CMS and JCAHO both look to NQF to standardize conflicting measures. An NQF-approved standard that is incorporated into CMS regulations as well as JCAHO accreditation procedures gives all three groups more clout.

"One key issue is trying to introduce enough standardization to reduce the data demands on hospitals," said Jared Loeb, executive VP of JCAHO's research division. "We must stop the madness of proliferating standards. We have to coalesce around common standards accepted by CMS, JCAHO, the Leapfrog Group, and other key players."

NQF-approved measures range from the use of aspirin and beta-blockers for acute myocardial infarction patients to prevention of urinary catheter-associated infection, antibiotic timing for pneumonia, smoking-cessation counseling, and antibiotic prophylaxis for postsurgical infections.