Nellie Bristol

WASHINGTON — From a liability perspective, health information technology remains a double-edged sword whose parameters still need to be spelled out, experts said at a meeting sponsored by eHealth Initiative and Bridges to Excellence.

"It's going to provide protection in some places and increase liability in others," said attorney Marcy Wilder, a partner with Hogan & Hartson.

When it comes to electronic clinical decision support (CDS) tools, Jud DeLoss, vice chair of the HIT Practice Group at the American Health Lawyers Association, recommended that physicians document their reasoning when they disregard the tool's suggestion.

Although it would be "difficult to pull off," attorneys could create a class of victims for whom they argue that clinical decision support was not followed, leading to detrimental results, he said. Conversely, attorneys could charge that a physician overly relied on the tool "and did not actually engage in the care they said they did."

Ms. Wilder pointed out another gray area created by HIT: delineating who contributed what sections to a patient's electronic health record.

"Look at the paper system," Ms. Wilder said. "We have handwriting and signatures, which are simple tools to identify who's responsible for which clinical applications, which provider made the diagnosis, who authorized the medication change. It is both easier and more difficult to do that with electronic health records."

The simplicity and efficacy of identity authentication will "depend upon the extent to which the vendors that are building the systems get this right," she added.

Although systems are in place to address identity authentication in health care institutions, problems may arise when data from shared information warehouses such as a regional health information organization are incorporated into an electronic medical record, Ms. Wilder said.

"That's where it's going to be very messy, and I think it will be a long time before we are going to be using shared data warehouses in part because of those kinds of liability issues," she said.

Physicians also are concerned about the validity of the portion of an electronic medical record that they did not make. Mr. DeLoss said the concern is that physicians might inadvertently become part of a malpractice suit by signing off on a medical record that also includes an entry by a physician who has a pending case.

Mr. DeLoss and Ms. Wilder added that as use of electronic medical records becomes more prevalent, physicians may have a duty to be familiar with a patient's entire medical record if it is available. They also recommended that physicians spell out with hospitals via contracts which party is liable for problems that arise from software donated to them by hospitals.

WASHINGTON — From a liability perspective, health information technology remains a double-edged sword whose parameters still need to be spelled out, experts said at a meeting sponsored by eHealth Initiative and Bridges to Excellence.

"It's going to provide protection in some places and increase liability in others," said attorney Marcy Wilder, a partner with Hogan & Hartson.

When it comes to electronic clinical decision support (CDS) tools, Jud DeLoss, vice chair of the HIT Practice Group at the American Health Lawyers Association, recommended that physicians document their reasoning when they disregard the tool's suggestion.

Although it would be "difficult to pull off," attorneys could create a class of victims for whom they argue that clinical decision support was not followed, leading to detrimental results, he said. Conversely, attorneys could charge that a physician overly relied on the tool "and did not actually engage in the care they said they did."

Ms. Wilder pointed out another gray area created by HIT: delineating who contributed what sections to a patient's electronic health record.

"Look at the paper system," Ms. Wilder said. "We have handwriting and signatures, which are simple tools to identify who's responsible for which clinical applications, which provider made the diagnosis, who authorized the medication change. It is both easier and more difficult to do that with electronic health records."

The simplicity and efficacy of identity authentication will "depend upon the extent to which the vendors that are building the systems get this right," she added.

Although systems are in place to address identity authentication in health care institutions, problems may arise when data from shared information warehouses such as a regional health information organization are incorporated into an electronic medical record, Ms. Wilder said.

"That's where it's going to be very messy, and I think it will be a long time before we are going to be using shared data warehouses in part because of those kinds of liability issues," she said.

Physicians also are concerned about the validity of the portion of an electronic medical record that they did not make. Mr. DeLoss said the concern is that physicians might inadvertently become part of a malpractice suit by signing off on a medical record that also includes an entry by a physician who has a pending case.

Mr. DeLoss and Ms. Wilder added that as use of electronic medical records becomes more prevalent, physicians may have a duty to be familiar with a patient's entire medical record if it is available. They also recommended that physicians spell out with hospitals via contracts which party is liable for problems that arise from software donated to them by hospitals.

WASHINGTON — From a liability perspective, health information technology remains a double-edged sword whose parameters still need to be spelled out, experts said at a meeting sponsored by eHealth Initiative and Bridges to Excellence.

"It's going to provide protection in some places and increase liability in others," said attorney Marcy Wilder, a partner with Hogan & Hartson.

When it comes to electronic clinical decision support (CDS) tools, Jud DeLoss, vice chair of the HIT Practice Group at the American Health Lawyers Association, recommended that physicians document their reasoning when they disregard the tool's suggestion.

Although it would be "difficult to pull off," attorneys could create a class of victims for whom they argue that clinical decision support was not followed, leading to detrimental results, he said. Conversely, attorneys could charge that a physician overly relied on the tool "and did not actually engage in the care they said they did."

Ms. Wilder pointed out another gray area created by HIT: delineating who contributed what sections to a patient's electronic health record.

"Look at the paper system," Ms. Wilder said. "We have handwriting and signatures, which are simple tools to identify who's responsible for which clinical applications, which provider made the diagnosis, who authorized the medication change. It is both easier and more difficult to do that with electronic health records."

The simplicity and efficacy of identity authentication will "depend upon the extent to which the vendors that are building the systems get this right," she added.

Although systems are in place to address identity authentication in health care institutions, problems may arise when data from shared information warehouses such as a regional health information organization are incorporated into an electronic medical record, Ms. Wilder said.

"That's where it's going to be very messy, and I think it will be a long time before we are going to be using shared data warehouses in part because of those kinds of liability issues," she said.

Physicians also are concerned about the validity of the portion of an electronic medical record that they did not make. Mr. DeLoss said the concern is that physicians might inadvertently become part of a malpractice suit by signing off on a medical record that also includes an entry by a physician who has a pending case.

Mr. DeLoss and Ms. Wilder added that as use of electronic medical records becomes more prevalent, physicians may have a duty to be familiar with a patient's entire medical record if it is available. They also recommended that physicians spell out with hospitals via contracts which party is liable for problems that arise from software donated to them by hospitals.

WASHINGTON — Schemes measuring the quality of health care services against price will emerge in some local markets for several procedures in the next 2 years, Secretary of Health and Human Services Mike Leavitt said at a meeting on health information technology sponsored by eHealth Initiative and Bridges to Excellence.

Within 5 years, Mr. Leavitt said, the term "value" will become part of the health care lexicon. "Within 10 years, value-based competition will have truly emerged."

Working toward that goal are six pilot projects being conducted by the Ambulatory Care Quality Alliance (AQA), Mr. Leavitt said. Supported by the Centers for Medicare and Medicaid Services and the Agency for Health Care Research and Quality (AHRQ), the pilot projects are testing approaches to aggregating and reporting both public and private data on physician performance. According to AQA, the programs "will not only measure quality, but will identify those high quality providers who are able to deliver efficient care to patients, avoiding unnecessary complications and cost."

Dr. Carolyn Clancy, AHRQ director, expanded on the purpose of the projects. "These pilots will begin to pave the way for showing how we can use the same set of measures … to try to figure out how can we report publicly on performance and, at least as important although probably not as rapidly, how do we get that information back to providers so they can improve." She added that other sites would be added to project shortly.

"We expect that when completed, the knowledge we develop through the AQA pilots will provide a comprehensive national framework for performance measurement and public reporting," she said.

While measurement will be conducted locally, Dr. Clancy said, it's important to have one set of measures used nationally. "If we're competing on different types of measures, we're not going to make any progress," she said.

AQA is a national coalition of 125 physician, consumer, business, insurer, and government organizations that are working to develop strategies for measuring, reporting, and improving performance at the physician level. The group developed a "starter set" of 26 standard performance measures last year that AQA says is "now being incorporated in physician contracts and implemented around the country." Measurements for hospital care are being developed by the Hospital Quality Alliance.

Mr. Leavitt said that, in addition to those two national alliances, he knows of 29 community-based quality measurement efforts, driven not only by businesses but also by physicians.

"The force that I believe must drive quality will be those who provide it, and the force that I have seen learning to measure quality [is] the physicians," he said. "This cannot simply be the MBAs ganging up on the MDs. This has got to be a collaborative effort because in every case where quality has been measured by one side without the other, it's been ineffective and less efficient."

Measuring quality is a key component of the Bush administration's policy to increase transparency and value in health care purchasing and delivery. The policy requires federal health care purchasers, including Medicare, Medicaid, and the Department of Veterans Affairs, to encourage the use of health information technology, share information about procedure prices, develop quality of care measures, and develop and identify approaches that facilitate high quality and efficient care. Part of the effort is to define "episode of care" units for frequent procedures in order to compare costs among providers.

"The important thing is that insurance companies and larger payers like the government are able to present their information in a form that the data can, in a privacy-protected way, be assembled into episodes of care for comparison," Mr. Leavitt said. "What is a hip replacement? What expense ought to be put into that bucket so we can compare one hospital or one physician to another?"

"During the next several months, we're going to see a tremendous push to combine the purchasing clout of the federal government with the health care buying power of the top 100 private employers in America—a public-private partnership on a scale we've never seen before to help health care consumers make more informed decisions about health care," Dr. Clancy said.

WASHINGTON — Schemes measuring the quality of health care services against price will emerge in some local markets for several procedures in the next 2 years, Secretary of Health and Human Services Mike Leavitt said at a meeting on health information technology sponsored by eHealth Initiative and Bridges to Excellence.

Within 5 years, Mr. Leavitt said, the term "value" will become part of the health care lexicon. "Within 10 years, value-based competition will have truly emerged."

Working toward that goal are six pilot projects being conducted by the Ambulatory Care Quality Alliance (AQA), Mr. Leavitt said. Supported by the Centers for Medicare and Medicaid Services and the Agency for Health Care Research and Quality (AHRQ), the pilot projects are testing approaches to aggregating and reporting both public and private data on physician performance. According to AQA, the programs "will not only measure quality, but will identify those high quality providers who are able to deliver efficient care to patients, avoiding unnecessary complications and cost."

Dr. Carolyn Clancy, AHRQ director, expanded on the purpose of the projects. "These pilots will begin to pave the way for showing how we can use the same set of measures … to try to figure out how can we report publicly on performance and, at least as important although probably not as rapidly, how do we get that information back to providers so they can improve." She added that other sites would be added to project shortly.

"We expect that when completed, the knowledge we develop through the AQA pilots will provide a comprehensive national framework for performance measurement and public reporting," she said.

While measurement will be conducted locally, Dr. Clancy said, it's important to have one set of measures used nationally. "If we're competing on different types of measures, we're not going to make any progress," she said.

AQA is a national coalition of 125 physician, consumer, business, insurer, and government organizations that are working to develop strategies for measuring, reporting, and improving performance at the physician level. The group developed a "starter set" of 26 standard performance measures last year that AQA says is "now being incorporated in physician contracts and implemented around the country." Measurements for hospital care are being developed by the Hospital Quality Alliance.

Mr. Leavitt said that, in addition to those two national alliances, he knows of 29 community-based quality measurement efforts, driven not only by businesses but also by physicians.

"The force that I believe must drive quality will be those who provide it, and the force that I have seen learning to measure quality [is] the physicians," he said. "This cannot simply be the MBAs ganging up on the MDs. This has got to be a collaborative effort because in every case where quality has been measured by one side without the other, it's been ineffective and less efficient."

Measuring quality is a key component of the Bush administration's policy to increase transparency and value in health care purchasing and delivery. The policy requires federal health care purchasers, including Medicare, Medicaid, and the Department of Veterans Affairs, to encourage the use of health information technology, share information about procedure prices, develop quality of care measures, and develop and identify approaches that facilitate high quality and efficient care. Part of the effort is to define "episode of care" units for frequent procedures in order to compare costs among providers.

"The important thing is that insurance companies and larger payers like the government are able to present their information in a form that the data can, in a privacy-protected way, be assembled into episodes of care for comparison," Mr. Leavitt said. "What is a hip replacement? What expense ought to be put into that bucket so we can compare one hospital or one physician to another?"

"During the next several months, we're going to see a tremendous push to combine the purchasing clout of the federal government with the health care buying power of the top 100 private employers in America—a public-private partnership on a scale we've never seen before to help health care consumers make more informed decisions about health care," Dr. Clancy said.

WASHINGTON — Schemes measuring the quality of health care services against price will emerge in some local markets for several procedures in the next 2 years, Secretary of Health and Human Services Mike Leavitt said at a meeting on health information technology sponsored by eHealth Initiative and Bridges to Excellence.

Within 5 years, Mr. Leavitt said, the term "value" will become part of the health care lexicon. "Within 10 years, value-based competition will have truly emerged."

Working toward that goal are six pilot projects being conducted by the Ambulatory Care Quality Alliance (AQA), Mr. Leavitt said. Supported by the Centers for Medicare and Medicaid Services and the Agency for Health Care Research and Quality (AHRQ), the pilot projects are testing approaches to aggregating and reporting both public and private data on physician performance. According to AQA, the programs "will not only measure quality, but will identify those high quality providers who are able to deliver efficient care to patients, avoiding unnecessary complications and cost."

Dr. Carolyn Clancy, AHRQ director, expanded on the purpose of the projects. "These pilots will begin to pave the way for showing how we can use the same set of measures … to try to figure out how can we report publicly on performance and, at least as important although probably not as rapidly, how do we get that information back to providers so they can improve." She added that other sites would be added to project shortly.

"We expect that when completed, the knowledge we develop through the AQA pilots will provide a comprehensive national framework for performance measurement and public reporting," she said.

While measurement will be conducted locally, Dr. Clancy said, it's important to have one set of measures used nationally. "If we're competing on different types of measures, we're not going to make any progress," she said.

AQA is a national coalition of 125 physician, consumer, business, insurer, and government organizations that are working to develop strategies for measuring, reporting, and improving performance at the physician level. The group developed a "starter set" of 26 standard performance measures last year that AQA says is "now being incorporated in physician contracts and implemented around the country." Measurements for hospital care are being developed by the Hospital Quality Alliance.

Mr. Leavitt said that, in addition to those two national alliances, he knows of 29 community-based quality measurement efforts, driven not only by businesses but also by physicians.

"The force that I believe must drive quality will be those who provide it, and the force that I have seen learning to measure quality [is] the physicians," he said. "This cannot simply be the MBAs ganging up on the MDs. This has got to be a collaborative effort because in every case where quality has been measured by one side without the other, it's been ineffective and less efficient."

Measuring quality is a key component of the Bush administration's policy to increase transparency and value in health care purchasing and delivery. The policy requires federal health care purchasers, including Medicare, Medicaid, and the Department of Veterans Affairs, to encourage the use of health information technology, share information about procedure prices, develop quality of care measures, and develop and identify approaches that facilitate high quality and efficient care. Part of the effort is to define "episode of care" units for frequent procedures in order to compare costs among providers.

"The important thing is that insurance companies and larger payers like the government are able to present their information in a form that the data can, in a privacy-protected way, be assembled into episodes of care for comparison," Mr. Leavitt said. "What is a hip replacement? What expense ought to be put into that bucket so we can compare one hospital or one physician to another?"

"During the next several months, we're going to see a tremendous push to combine the purchasing clout of the federal government with the health care buying power of the top 100 private employers in America—a public-private partnership on a scale we've never seen before to help health care consumers make more informed decisions about health care," Dr. Clancy said.

WASHINGTON — A total of $1.4 million in pay-for-performance rewards was distributed to physicians in 20 group practices that participated in a pilot project sponsored by CareFirst BlueCross BlueShield, Dr. Jon Shematek said at a meeting on health information technology sponsored by eHealth Initiative and Bridges to Excellence.

Thirty practices initially were selected for participation in the first year of a $4.5 million, 3-year project, said Dr. Shematek, vice president for quality and medical policy at CareFirst.

Eight of the practices dropped out, and rewards were given to the remaining practices that met National Committee for Quality Assurance certification requirements.

The practices are located primarily in Maryland but also in Delaware and the District of Columbia and they treat a combined total of 50,000 patients.

CareFirst used the Bridges to Excellence model program, which was developed by a group of employers, insurers, and physicians.

Standards met by physicians addressed clinical information systems, use of evidence-based medicine, patient education and support, and care management. Seventeen groups passed at a basic level, and three passed at an intermediate level, Dr. Shematek said. No groups passed at an advanced level.

Of the pilot practices, 14 had paper medical records, while 6 had partial electronic records, he added.

The practice improvements implemented by the groups included chronic disease registries and follow-up, electronic prescribing, follow-up of inpatient admissions and emergency department visits, improved rates of colonoscopy screening and diabetes eye exams, and enhanced patient education material, he explained.

Certified practices receive program recognition via a National Committee for Quality Assurance “practice connections” seal. The practices can use this seal in their advertising.

Dr. Shematek said CareFirst is now looking at proposals from academic centers to evaluate quality, utilization, and cost of the program “as well as what qualitatively changed in the practice and what motivated doctors to participate.”

Participating practices will be compared with a control of nonparticipating groups.

WASHINGTON — A total of $1.4 million in pay-for-performance rewards was distributed to physicians in 20 group practices that participated in a pilot project sponsored by CareFirst BlueCross BlueShield, Dr. Jon Shematek said at a meeting on health information technology sponsored by eHealth Initiative and Bridges to Excellence.

Thirty practices initially were selected for participation in the first year of a $4.5 million, 3-year project, said Dr. Shematek, vice president for quality and medical policy at CareFirst.

Eight of the practices dropped out, and rewards were given to the remaining practices that met National Committee for Quality Assurance certification requirements.

The practices are located primarily in Maryland but also in Delaware and the District of Columbia and they treat a combined total of 50,000 patients.

CareFirst used the Bridges to Excellence model program, which was developed by a group of employers, insurers, and physicians.

Standards met by physicians addressed clinical information systems, use of evidence-based medicine, patient education and support, and care management. Seventeen groups passed at a basic level, and three passed at an intermediate level, Dr. Shematek said. No groups passed at an advanced level.

Of the pilot practices, 14 had paper medical records, while 6 had partial electronic records, he added.

The practice improvements implemented by the groups included chronic disease registries and follow-up, electronic prescribing, follow-up of inpatient admissions and emergency department visits, improved rates of colonoscopy screening and diabetes eye exams, and enhanced patient education material, he explained.

Certified practices receive program recognition via a National Committee for Quality Assurance “practice connections” seal. The practices can use this seal in their advertising.

Dr. Shematek said CareFirst is now looking at proposals from academic centers to evaluate quality, utilization, and cost of the program “as well as what qualitatively changed in the practice and what motivated doctors to participate.”

Participating practices will be compared with a control of nonparticipating groups.

WASHINGTON — A total of $1.4 million in pay-for-performance rewards was distributed to physicians in 20 group practices that participated in a pilot project sponsored by CareFirst BlueCross BlueShield, Dr. Jon Shematek said at a meeting on health information technology sponsored by eHealth Initiative and Bridges to Excellence.

Thirty practices initially were selected for participation in the first year of a $4.5 million, 3-year project, said Dr. Shematek, vice president for quality and medical policy at CareFirst.

Eight of the practices dropped out, and rewards were given to the remaining practices that met National Committee for Quality Assurance certification requirements.

The practices are located primarily in Maryland but also in Delaware and the District of Columbia and they treat a combined total of 50,000 patients.

CareFirst used the Bridges to Excellence model program, which was developed by a group of employers, insurers, and physicians.

Standards met by physicians addressed clinical information systems, use of evidence-based medicine, patient education and support, and care management. Seventeen groups passed at a basic level, and three passed at an intermediate level, Dr. Shematek said. No groups passed at an advanced level.

Of the pilot practices, 14 had paper medical records, while 6 had partial electronic records, he added.

The practice improvements implemented by the groups included chronic disease registries and follow-up, electronic prescribing, follow-up of inpatient admissions and emergency department visits, improved rates of colonoscopy screening and diabetes eye exams, and enhanced patient education material, he explained.

Certified practices receive program recognition via a National Committee for Quality Assurance “practice connections” seal. The practices can use this seal in their advertising.

Dr. Shematek said CareFirst is now looking at proposals from academic centers to evaluate quality, utilization, and cost of the program “as well as what qualitatively changed in the practice and what motivated doctors to participate.”

Participating practices will be compared with a control of nonparticipating groups.

WASHINGTON — Schemes measuring the quality of health care services against price will emerge in some local markets for several procedures in the next 2 years, Secretary of Health and Human Services Mike Leavitt said at a meeting on health information technology sponsored by eHealth Initiative and Bridges to Excellence.

Within 5 years, Mr. Leavitt said, the term “value” will become part of the health care lexicon. “Within 10 years, value-based competition will have truly emerged.”

Working toward that goal are six pilot projects being conducted by the Ambulatory Care Quality Alliance (AQA), Mr. Leavitt said. Supported by the Centers for Medicare and Medicaid Services and the Agency for Health Care Research and Quality (AHRQ), the pilot projects are testing approaches to aggregating and reporting both public and private data on physician performance.

According to AQA, the programs “will not only measure quality, but will identify those high-quality providers who are able to deliver efficient care to patients, avoiding unnecessary complications and cost.”

Dr. Carolyn Clancy, AHRQ director, expanded on the purpose of the projects. “These pilots will begin to pave the way for showing how we can use the same set of measures … to try to figure out how we can report publicly on performance and, at least as important although probably not as rapidly, how we get that information back to providers so they can improve.” She added that other sites would be added to the project shortly.

“We expect that when completed, the knowledge we develop through the AQA pilots will provide a comprehensive national framework for performance measurement and public reporting,” she said.

While measurement will be conducted locally, Dr. Clancy said, it's important to have one set of measures used nationally.

AQA is a national coalition of 125 physician, consumer, business, insurer, and government organizations that are working to develop strategies for measuring, reporting, and improving performance at the physician level. The group developed a “starter set” of 26 standard performance measures last year that AQA says is “now being incorporated in physician contracts and implemented around the country.” Measurements for hospital care are being developed by the Hospital Quality Alliance.

Mr. Leavitt said that, in addition to those two national alliances, he knows of 29 community-based quality measurement efforts, driven not only by businesses but also by physicians.

“The force that I believe must drive quality will be those who provide it, and the force that I have seen learning to measure quality [is] the physicians,” he said. “This cannot simply be the MBAs ganging up on the MDs. This has got to be a collaborative effort.”

Measuring quality is a key component of the Bush administration's policy to increase transparency and value in health care purchasing and delivery. The policy requires federal health care purchasers, including Medicare, Medicaid, and the Department of Veterans Affairs, to encourage the use of health information technology, share information about procedure prices, develop quality of care measures, and develop and identify approaches that facilitate high quality and efficient care.

Part of the effort is to define “episodes of care” for frequent procedures that can be used as units by which to compare costs among providers.

“The important thing is that insurance companies and larger payers like the government are able to present their information in a form that the data can, in a privacy-protected way, be assembled into episodes of care for comparison,” Mr. Leavitt said. “What is a hip replacement? What expense ought to be put into that bucket so we can compare one hospital or one physician to another”

Mr. Leavitt and Dr. Clancy said the Bush administration's goal is to merge the insurance market power of the federal government with that of the private sector to move value-based competition along.

“During the next several months, we're going to see a tremendous push to combine the purchasing clout of the federal government with the health care buying power of the top 100 private employers in America,” Dr. Clancy said.

WASHINGTON — Schemes measuring the quality of health care services against price will emerge in some local markets for several procedures in the next 2 years, Secretary of Health and Human Services Mike Leavitt said at a meeting on health information technology sponsored by eHealth Initiative and Bridges to Excellence.

Within 5 years, Mr. Leavitt said, the term “value” will become part of the health care lexicon. “Within 10 years, value-based competition will have truly emerged.”

Working toward that goal are six pilot projects being conducted by the Ambulatory Care Quality Alliance (AQA), Mr. Leavitt said. Supported by the Centers for Medicare and Medicaid Services and the Agency for Health Care Research and Quality (AHRQ), the pilot projects are testing approaches to aggregating and reporting both public and private data on physician performance.

According to AQA, the programs “will not only measure quality, but will identify those high-quality providers who are able to deliver efficient care to patients, avoiding unnecessary complications and cost.”

Dr. Carolyn Clancy, AHRQ director, expanded on the purpose of the projects. “These pilots will begin to pave the way for showing how we can use the same set of measures … to try to figure out how we can report publicly on performance and, at least as important although probably not as rapidly, how we get that information back to providers so they can improve.” She added that other sites would be added to the project shortly.

“We expect that when completed, the knowledge we develop through the AQA pilots will provide a comprehensive national framework for performance measurement and public reporting,” she said.

While measurement will be conducted locally, Dr. Clancy said, it's important to have one set of measures used nationally.

AQA is a national coalition of 125 physician, consumer, business, insurer, and government organizations that are working to develop strategies for measuring, reporting, and improving performance at the physician level. The group developed a “starter set” of 26 standard performance measures last year that AQA says is “now being incorporated in physician contracts and implemented around the country.” Measurements for hospital care are being developed by the Hospital Quality Alliance.

Mr. Leavitt said that, in addition to those two national alliances, he knows of 29 community-based quality measurement efforts, driven not only by businesses but also by physicians.

“The force that I believe must drive quality will be those who provide it, and the force that I have seen learning to measure quality [is] the physicians,” he said. “This cannot simply be the MBAs ganging up on the MDs. This has got to be a collaborative effort.”

Measuring quality is a key component of the Bush administration's policy to increase transparency and value in health care purchasing and delivery. The policy requires federal health care purchasers, including Medicare, Medicaid, and the Department of Veterans Affairs, to encourage the use of health information technology, share information about procedure prices, develop quality of care measures, and develop and identify approaches that facilitate high quality and efficient care.

Part of the effort is to define “episodes of care” for frequent procedures that can be used as units by which to compare costs among providers.

“The important thing is that insurance companies and larger payers like the government are able to present their information in a form that the data can, in a privacy-protected way, be assembled into episodes of care for comparison,” Mr. Leavitt said. “What is a hip replacement? What expense ought to be put into that bucket so we can compare one hospital or one physician to another”

Mr. Leavitt and Dr. Clancy said the Bush administration's goal is to merge the insurance market power of the federal government with that of the private sector to move value-based competition along.

“During the next several months, we're going to see a tremendous push to combine the purchasing clout of the federal government with the health care buying power of the top 100 private employers in America,” Dr. Clancy said.

WASHINGTON — Schemes measuring the quality of health care services against price will emerge in some local markets for several procedures in the next 2 years, Secretary of Health and Human Services Mike Leavitt said at a meeting on health information technology sponsored by eHealth Initiative and Bridges to Excellence.

Within 5 years, Mr. Leavitt said, the term “value” will become part of the health care lexicon. “Within 10 years, value-based competition will have truly emerged.”

Working toward that goal are six pilot projects being conducted by the Ambulatory Care Quality Alliance (AQA), Mr. Leavitt said. Supported by the Centers for Medicare and Medicaid Services and the Agency for Health Care Research and Quality (AHRQ), the pilot projects are testing approaches to aggregating and reporting both public and private data on physician performance.

According to AQA, the programs “will not only measure quality, but will identify those high-quality providers who are able to deliver efficient care to patients, avoiding unnecessary complications and cost.”

Dr. Carolyn Clancy, AHRQ director, expanded on the purpose of the projects. “These pilots will begin to pave the way for showing how we can use the same set of measures … to try to figure out how we can report publicly on performance and, at least as important although probably not as rapidly, how we get that information back to providers so they can improve.” She added that other sites would be added to the project shortly.

“We expect that when completed, the knowledge we develop through the AQA pilots will provide a comprehensive national framework for performance measurement and public reporting,” she said.

While measurement will be conducted locally, Dr. Clancy said, it's important to have one set of measures used nationally.

AQA is a national coalition of 125 physician, consumer, business, insurer, and government organizations that are working to develop strategies for measuring, reporting, and improving performance at the physician level. The group developed a “starter set” of 26 standard performance measures last year that AQA says is “now being incorporated in physician contracts and implemented around the country.” Measurements for hospital care are being developed by the Hospital Quality Alliance.

Mr. Leavitt said that, in addition to those two national alliances, he knows of 29 community-based quality measurement efforts, driven not only by businesses but also by physicians.

“The force that I believe must drive quality will be those who provide it, and the force that I have seen learning to measure quality [is] the physicians,” he said. “This cannot simply be the MBAs ganging up on the MDs. This has got to be a collaborative effort.”

Measuring quality is a key component of the Bush administration's policy to increase transparency and value in health care purchasing and delivery. The policy requires federal health care purchasers, including Medicare, Medicaid, and the Department of Veterans Affairs, to encourage the use of health information technology, share information about procedure prices, develop quality of care measures, and develop and identify approaches that facilitate high quality and efficient care.

Part of the effort is to define “episodes of care” for frequent procedures that can be used as units by which to compare costs among providers.

“The important thing is that insurance companies and larger payers like the government are able to present their information in a form that the data can, in a privacy-protected way, be assembled into episodes of care for comparison,” Mr. Leavitt said. “What is a hip replacement? What expense ought to be put into that bucket so we can compare one hospital or one physician to another”

Mr. Leavitt and Dr. Clancy said the Bush administration's goal is to merge the insurance market power of the federal government with that of the private sector to move value-based competition along.

“During the next several months, we're going to see a tremendous push to combine the purchasing clout of the federal government with the health care buying power of the top 100 private employers in America,” Dr. Clancy said.

WASHINGTON — From a liability perspective, health information technology remains a double-edged sword whose parameters still need to be spelled out, experts said at a meeting sponsored by eHealth Initiative and Bridges to Excellence.

“It's going to provide protection in some places and increase liability in others,” said attorney Marcy Wilder, a partner with Hogan & Hartson.

When it comes to electronic clinical decision support (CDS) tools, Jud DeLoss, vice chair of the HIT Practice Group at the American Health Lawyers Association, recommended that physicians document their reasoning when they disregard the tool's suggestion.

Although it would be “difficult to pull off,” attorneys could create a class of victims for whom they argue that clinical decision support was not followed, leading to detrimental results, he said. Conversely, attorneys could charge that a physician overly relied on the tool “and did not actually engage in the care they said they did.”

Another gray area created by HIT: delineating who contributed what sections to a patient's electronic health record.

“Look at the paper system,” Ms. Wilder said. “We have handwriting and signatures, which are simple tools to identify who's responsible for which clinical applications, which provider made the diagnosis, who authorized the medication change. It is both easier and more difficult to do that with electronic health records.”

Although systems are in place to address identity authentication in health care institutions, problems may arise when data from shared information warehouses such as a regional health information organization are incorporated into an electronic medical record, Ms. Wilder said.

“That's where it's going to be very messy, and I think it will be a long time before we are going to be using shared data warehouses in part because of those kinds of liability issues,” she said.

Physicians also are concerned about the validity of the portion of an electronic medical record that they did not make. Mr. DeLoss said the concern is that physicians might inadvertently end up becoming part of a malpractice suit by signing off on their portion of a medical record that also includes an entry by a physician who has a pending malpractice case

WASHINGTON — From a liability perspective, health information technology remains a double-edged sword whose parameters still need to be spelled out, experts said at a meeting sponsored by eHealth Initiative and Bridges to Excellence.

“It's going to provide protection in some places and increase liability in others,” said attorney Marcy Wilder, a partner with Hogan & Hartson.

When it comes to electronic clinical decision support (CDS) tools, Jud DeLoss, vice chair of the HIT Practice Group at the American Health Lawyers Association, recommended that physicians document their reasoning when they disregard the tool's suggestion.

Although it would be “difficult to pull off,” attorneys could create a class of victims for whom they argue that clinical decision support was not followed, leading to detrimental results, he said. Conversely, attorneys could charge that a physician overly relied on the tool “and did not actually engage in the care they said they did.”

Another gray area created by HIT: delineating who contributed what sections to a patient's electronic health record.

“Look at the paper system,” Ms. Wilder said. “We have handwriting and signatures, which are simple tools to identify who's responsible for which clinical applications, which provider made the diagnosis, who authorized the medication change. It is both easier and more difficult to do that with electronic health records.”

Although systems are in place to address identity authentication in health care institutions, problems may arise when data from shared information warehouses such as a regional health information organization are incorporated into an electronic medical record, Ms. Wilder said.

“That's where it's going to be very messy, and I think it will be a long time before we are going to be using shared data warehouses in part because of those kinds of liability issues,” she said.

Physicians also are concerned about the validity of the portion of an electronic medical record that they did not make. Mr. DeLoss said the concern is that physicians might inadvertently end up becoming part of a malpractice suit by signing off on their portion of a medical record that also includes an entry by a physician who has a pending malpractice case

WASHINGTON — From a liability perspective, health information technology remains a double-edged sword whose parameters still need to be spelled out, experts said at a meeting sponsored by eHealth Initiative and Bridges to Excellence.

“It's going to provide protection in some places and increase liability in others,” said attorney Marcy Wilder, a partner with Hogan & Hartson.

When it comes to electronic clinical decision support (CDS) tools, Jud DeLoss, vice chair of the HIT Practice Group at the American Health Lawyers Association, recommended that physicians document their reasoning when they disregard the tool's suggestion.

Although it would be “difficult to pull off,” attorneys could create a class of victims for whom they argue that clinical decision support was not followed, leading to detrimental results, he said. Conversely, attorneys could charge that a physician overly relied on the tool “and did not actually engage in the care they said they did.”

Another gray area created by HIT: delineating who contributed what sections to a patient's electronic health record.

“Look at the paper system,” Ms. Wilder said. “We have handwriting and signatures, which are simple tools to identify who's responsible for which clinical applications, which provider made the diagnosis, who authorized the medication change. It is both easier and more difficult to do that with electronic health records.”

Although systems are in place to address identity authentication in health care institutions, problems may arise when data from shared information warehouses such as a regional health information organization are incorporated into an electronic medical record, Ms. Wilder said.

“That's where it's going to be very messy, and I think it will be a long time before we are going to be using shared data warehouses in part because of those kinds of liability issues,” she said.

Physicians also are concerned about the validity of the portion of an electronic medical record that they did not make. Mr. DeLoss said the concern is that physicians might inadvertently end up becoming part of a malpractice suit by signing off on their portion of a medical record that also includes an entry by a physician who has a pending malpractice case

WASHINGTON — Pay-for-performance rewards totaling $1.4 million were distributed to physicians in 20 group practices in a pilot project sponsored by CareFirst BlueCross BlueShield, Dr. Jon Shematek said at a meeting on health information technology sponsored by eHealth Initiative and Bridges to Excellence.

Thirty practices initially were selected for participation in the first year of a $4.5 million, 3-year project, said Dr. Shematek, vice president for quality and medical policy at CareFirst. Eight dropped out and rewards were given to the remaining practices that met National Committee for Quality Assurance certification requirements.

CareFirst used the Bridges to Excellence model program developed by a group of employers, insurers, and physicians. Standards met by physicians addressed clinical information systems, use of evidence-based medicine, patient education and support, and care management. Of the 20 practices, 17 passed at a basic level and 3 passed at an intermediate level; 14 had paper medical records and 6 had partial electronic records.

Practice improvements included chronic disease registries and follow-up, electronic prescribing, follow-up of emergency department visits and inpatient admissions, and improved rates of colonoscopy screening and diabetes eye exams. Certified practices receive program recognition via a “practice connections” seal they can use in advertising.

WASHINGTON — Pay-for-performance rewards totaling $1.4 million were distributed to physicians in 20 group practices in a pilot project sponsored by CareFirst BlueCross BlueShield, Dr. Jon Shematek said at a meeting on health information technology sponsored by eHealth Initiative and Bridges to Excellence.

Thirty practices initially were selected for participation in the first year of a $4.5 million, 3-year project, said Dr. Shematek, vice president for quality and medical policy at CareFirst. Eight dropped out and rewards were given to the remaining practices that met National Committee for Quality Assurance certification requirements.

CareFirst used the Bridges to Excellence model program developed by a group of employers, insurers, and physicians. Standards met by physicians addressed clinical information systems, use of evidence-based medicine, patient education and support, and care management. Of the 20 practices, 17 passed at a basic level and 3 passed at an intermediate level; 14 had paper medical records and 6 had partial electronic records.

Practice improvements included chronic disease registries and follow-up, electronic prescribing, follow-up of emergency department visits and inpatient admissions, and improved rates of colonoscopy screening and diabetes eye exams. Certified practices receive program recognition via a “practice connections” seal they can use in advertising.

WASHINGTON — Pay-for-performance rewards totaling $1.4 million were distributed to physicians in 20 group practices in a pilot project sponsored by CareFirst BlueCross BlueShield, Dr. Jon Shematek said at a meeting on health information technology sponsored by eHealth Initiative and Bridges to Excellence.

Thirty practices initially were selected for participation in the first year of a $4.5 million, 3-year project, said Dr. Shematek, vice president for quality and medical policy at CareFirst. Eight dropped out and rewards were given to the remaining practices that met National Committee for Quality Assurance certification requirements.

CareFirst used the Bridges to Excellence model program developed by a group of employers, insurers, and physicians. Standards met by physicians addressed clinical information systems, use of evidence-based medicine, patient education and support, and care management. Of the 20 practices, 17 passed at a basic level and 3 passed at an intermediate level; 14 had paper medical records and 6 had partial electronic records.

Practice improvements included chronic disease registries and follow-up, electronic prescribing, follow-up of emergency department visits and inpatient admissions, and improved rates of colonoscopy screening and diabetes eye exams. Certified practices receive program recognition via a “practice connections” seal they can use in advertising.

WASHINGTON — Schemes measuring the quality of health care services against price will emerge in some local markets for several procedures in the next 2 years, Secretary of Health and Human Services Mike Leavitt said at a meeting on health information technology sponsored by eHealth Initiative and Bridges to Excellence.

Within 5 years, Mr. Leavitt said, the term “value” will become part of the health care lexicon. “Within 10 years, value-based competition will have truly emerged.”

Working toward that goal are six pilot projects being conducted by the Ambulatory Care Quality Alliance (AQA), Mr. Leavitt said. Supported by the Centers for Medicare and Medicaid Services and the Agency for Health Care Research and Quality (AHRQ), the pilot projects are testing approaches to aggregating and reporting both public and private data on physician performance. According to AQA, the programs “will not only measure quality, but will identify those high quality providers who are able to deliver efficient care to patients, avoiding unnecessary complications and cost.”

Dr. Carolyn Clancy, AHRQ director, expanded on the purpose of the projects. “These pilots will begin to pave the way for showing how we can use the same set of measures … to try to figure out how can we report publicly on performance and, at least as important although probably not as rapidly, how do we get that information back to providers so they can improve.” She added that other sites would be added to the project shortly.

“We expect that when completed, the knowledge we develop through the AQA pilots will provide a comprehensive national framework for performance measurement and public reporting,” she said.

Although measurement will be conducted locally, Dr. Clancy said, it's important to have one set of measures used nationally. “If we're competing on different types of measures, we're not going to make any progress,” she said.

AQA is a national coalition of 125 physician, consumer, business, insurer, and government organizations that are working to develop strategies for measuring, reporting, and improving performance at the physician level. The group developed a “starter set” of 26 standard performance measures last year that AQA says is “now being incorporated in physician contracts and implemented around the country.” Measurements for hospital care are being developed by the Hospital Quality Alliance.

Mr. Leavitt said that, in addition to those two national alliances, he knows of 29 community-based quality measurement efforts, driven not only by businesses but also by physicians.

“The force that I believe must drive quality will be those who provide it, and the force that I have seen learning to measure quality [is] the physicians,” he said. “This cannot simply be the MBAs ganging up on the MDs. This has got to be a collaborative effort because in every case where quality has been measured by one side without the other, it's been ineffective and less efficient.”

Measuring quality is a key component of the Bush administration's policy to increase transparency and value in health care purchasing and delivery. The policy requires federal health care purchasers, including Medicare, Medicaid, and the Department of Veterans Affairs, to encourage the use of health information technology, share information about prices, develop quality of care measures, and develop approaches that facilitate high quality and efficient care. Part of the effort is to define “episodes of care” for frequent procedures that can be used as units to compare costs among providers.

“The important thing is that insurance companies and larger payers like the government are able to present their information in a form that the data can, in a privacy-protected way, be assembled into episodes of care for comparison,” Mr. Leavitt said. “What is a hip replacement? What expense ought to be put into that bucket so we can compare one hospital or one physician to another?”

Mr. Leavitt and Dr. Clancy said the Bush administration's goal is to merge the insurance market power of the federal government with that of the private sector to move value-based competition along.

In the next few months, “we're going to see a tremendous push to combine the purchasing clout of the federal government with the health care buying power of the top 100 private employers in America—a public-private partnership on a scale we've never seen before to help health care consumers make more informed decisions about health care,” Dr. Clancy said.

WASHINGTON — Schemes measuring the quality of health care services against price will emerge in some local markets for several procedures in the next 2 years, Secretary of Health and Human Services Mike Leavitt said at a meeting on health information technology sponsored by eHealth Initiative and Bridges to Excellence.

Within 5 years, Mr. Leavitt said, the term “value” will become part of the health care lexicon. “Within 10 years, value-based competition will have truly emerged.”

Working toward that goal are six pilot projects being conducted by the Ambulatory Care Quality Alliance (AQA), Mr. Leavitt said. Supported by the Centers for Medicare and Medicaid Services and the Agency for Health Care Research and Quality (AHRQ), the pilot projects are testing approaches to aggregating and reporting both public and private data on physician performance. According to AQA, the programs “will not only measure quality, but will identify those high quality providers who are able to deliver efficient care to patients, avoiding unnecessary complications and cost.”

Dr. Carolyn Clancy, AHRQ director, expanded on the purpose of the projects. “These pilots will begin to pave the way for showing how we can use the same set of measures … to try to figure out how can we report publicly on performance and, at least as important although probably not as rapidly, how do we get that information back to providers so they can improve.” She added that other sites would be added to the project shortly.

“We expect that when completed, the knowledge we develop through the AQA pilots will provide a comprehensive national framework for performance measurement and public reporting,” she said.

Although measurement will be conducted locally, Dr. Clancy said, it's important to have one set of measures used nationally. “If we're competing on different types of measures, we're not going to make any progress,” she said.

AQA is a national coalition of 125 physician, consumer, business, insurer, and government organizations that are working to develop strategies for measuring, reporting, and improving performance at the physician level. The group developed a “starter set” of 26 standard performance measures last year that AQA says is “now being incorporated in physician contracts and implemented around the country.” Measurements for hospital care are being developed by the Hospital Quality Alliance.

Mr. Leavitt said that, in addition to those two national alliances, he knows of 29 community-based quality measurement efforts, driven not only by businesses but also by physicians.

“The force that I believe must drive quality will be those who provide it, and the force that I have seen learning to measure quality [is] the physicians,” he said. “This cannot simply be the MBAs ganging up on the MDs. This has got to be a collaborative effort because in every case where quality has been measured by one side without the other, it's been ineffective and less efficient.”

Measuring quality is a key component of the Bush administration's policy to increase transparency and value in health care purchasing and delivery. The policy requires federal health care purchasers, including Medicare, Medicaid, and the Department of Veterans Affairs, to encourage the use of health information technology, share information about prices, develop quality of care measures, and develop approaches that facilitate high quality and efficient care. Part of the effort is to define “episodes of care” for frequent procedures that can be used as units to compare costs among providers.

“The important thing is that insurance companies and larger payers like the government are able to present their information in a form that the data can, in a privacy-protected way, be assembled into episodes of care for comparison,” Mr. Leavitt said. “What is a hip replacement? What expense ought to be put into that bucket so we can compare one hospital or one physician to another?”

Mr. Leavitt and Dr. Clancy said the Bush administration's goal is to merge the insurance market power of the federal government with that of the private sector to move value-based competition along.

In the next few months, “we're going to see a tremendous push to combine the purchasing clout of the federal government with the health care buying power of the top 100 private employers in America—a public-private partnership on a scale we've never seen before to help health care consumers make more informed decisions about health care,” Dr. Clancy said.

WASHINGTON — Schemes measuring the quality of health care services against price will emerge in some local markets for several procedures in the next 2 years, Secretary of Health and Human Services Mike Leavitt said at a meeting on health information technology sponsored by eHealth Initiative and Bridges to Excellence.

Within 5 years, Mr. Leavitt said, the term “value” will become part of the health care lexicon. “Within 10 years, value-based competition will have truly emerged.”

Working toward that goal are six pilot projects being conducted by the Ambulatory Care Quality Alliance (AQA), Mr. Leavitt said. Supported by the Centers for Medicare and Medicaid Services and the Agency for Health Care Research and Quality (AHRQ), the pilot projects are testing approaches to aggregating and reporting both public and private data on physician performance. According to AQA, the programs “will not only measure quality, but will identify those high quality providers who are able to deliver efficient care to patients, avoiding unnecessary complications and cost.”

Dr. Carolyn Clancy, AHRQ director, expanded on the purpose of the projects. “These pilots will begin to pave the way for showing how we can use the same set of measures … to try to figure out how can we report publicly on performance and, at least as important although probably not as rapidly, how do we get that information back to providers so they can improve.” She added that other sites would be added to the project shortly.

“We expect that when completed, the knowledge we develop through the AQA pilots will provide a comprehensive national framework for performance measurement and public reporting,” she said.

Although measurement will be conducted locally, Dr. Clancy said, it's important to have one set of measures used nationally. “If we're competing on different types of measures, we're not going to make any progress,” she said.

AQA is a national coalition of 125 physician, consumer, business, insurer, and government organizations that are working to develop strategies for measuring, reporting, and improving performance at the physician level. The group developed a “starter set” of 26 standard performance measures last year that AQA says is “now being incorporated in physician contracts and implemented around the country.” Measurements for hospital care are being developed by the Hospital Quality Alliance.

Mr. Leavitt said that, in addition to those two national alliances, he knows of 29 community-based quality measurement efforts, driven not only by businesses but also by physicians.

“The force that I believe must drive quality will be those who provide it, and the force that I have seen learning to measure quality [is] the physicians,” he said. “This cannot simply be the MBAs ganging up on the MDs. This has got to be a collaborative effort because in every case where quality has been measured by one side without the other, it's been ineffective and less efficient.”

Measuring quality is a key component of the Bush administration's policy to increase transparency and value in health care purchasing and delivery. The policy requires federal health care purchasers, including Medicare, Medicaid, and the Department of Veterans Affairs, to encourage the use of health information technology, share information about prices, develop quality of care measures, and develop approaches that facilitate high quality and efficient care. Part of the effort is to define “episodes of care” for frequent procedures that can be used as units to compare costs among providers.

“The important thing is that insurance companies and larger payers like the government are able to present their information in a form that the data can, in a privacy-protected way, be assembled into episodes of care for comparison,” Mr. Leavitt said. “What is a hip replacement? What expense ought to be put into that bucket so we can compare one hospital or one physician to another?”

Mr. Leavitt and Dr. Clancy said the Bush administration's goal is to merge the insurance market power of the federal government with that of the private sector to move value-based competition along.

In the next few months, “we're going to see a tremendous push to combine the purchasing clout of the federal government with the health care buying power of the top 100 private employers in America—a public-private partnership on a scale we've never seen before to help health care consumers make more informed decisions about health care,” Dr. Clancy said.

WASHINGTON — Schemes measuring the quality of health care services against price will emerge in some local markets for several procedures in the next 2 years, Secretary of Health and Human Services Mike Leavitt said at a meeting on health information technology sponsored by eHealth Initiative and Bridges to Excellence.

Within 5 years, Mr. Leavitt said, the term “value” will become part of the health care lexicon. “Within 10 years, value-based competition will have truly emerged.”

Working toward that goal are six pilot projects being conducted by the Ambulatory Care Quality Alliance (AQA), Mr. Leavitt said. Supported by the Centers for Medicare and Medicaid Services and the Agency for Health Care Research and Quality (AHRQ), the pilot projects are testing approaches to aggregating and reporting both public and private data on physician performance. According to AQA, the programs “will not only measure quality, but will identify those high quality providers who are able to deliver efficient care to patients, avoiding unnecessary complications and cost.”

Dr. Carolyn Clancy, AHRQ director, expanded on the purpose of the projects. “These pilots will begin to pave the way for showing how we can use the same set of measures … to try to figure out how can we report publicly on performance and, at least as important although probably not as rapidly, how do we get that information back to providers so they can improve.” She added that other sites would be added to the project shortly.

“We expect that when completed, the knowledge we develop through the AQA pilots will provide a comprehensive national framework for performance measurement and public reporting,” she said.

Although measurement will be conducted locally, Dr. Clancy said, it will still be important to have one set of measures used nationally. “If we're competing on different types of measures, we're not going to make any progress,” she said.

AQA is a national coalition of 125 physician, consumer, business, insurer, and government organizations that are working to develop strategies for measuring, reporting, and improving performance at the physician level. The group developed a “starter set” of 26 standard performance measures last year that AQA says is “now being incorporated in physician contracts and implemented around the country.” Measurements for hospital care are being developed by the Hospital Quality Alliance.

Mr. Leavitt said that, in addition to those two national alliances, he knows of 29 community-based quality measurement efforts, driven not only by businesses but also by physicians.

“The force that I believe must drive quality will be those who provide it, and the force that I have seen learning to measure quality [is] the physicians,” he said. “This cannot simply be the MBAs ganging up on the MDs. This has got to be a collaborative effort because in every case where quality has been measured by one side without the other, it's been ineffective and less efficient.”

Measuring quality is a key component of the Bush administration's policy to increase transparency and value in health care purchasing and delivery. The policy requires federal health care purchasers, including Medicare, Medicaid, and the Department of Veterans Affairs, to encourage the use of health information technology, share information about procedure prices, develop quality of care measures, and develop and identify approaches that facilitate high quality and efficient care.

Part of the effort is to define “episodes of care” for frequent procedures that can be used as units by which to compare costs among providers.

“The important thing is that insurance companies and larger payers like the government are able to present their information in a form that the data can, in a privacy- protected way, be assembled into episodes of care for comparison,” Mr. Leavitt said. “What is a hip replacement? What expense ought to be put into that bucket so we can compare one hospital or one physician to another?”

Mr. Leavitt and Dr. Clancy said the Bush administration's goal is to merge the insurance market power of the federal government with that of the private sector to move value-based competition along.

“During the next several months, we're going to see a tremendous push to combine the purchasing clout of the federal government with the health care buying power of the top 100 private employers in America—a public- private partnership on a scale we've never seen before to help health care consumers make more informed decisions about health care,” Dr. Clancy said.

WASHINGTON — Schemes measuring the quality of health care services against price will emerge in some local markets for several procedures in the next 2 years, Secretary of Health and Human Services Mike Leavitt said at a meeting on health information technology sponsored by eHealth Initiative and Bridges to Excellence.

Within 5 years, Mr. Leavitt said, the term “value” will become part of the health care lexicon. “Within 10 years, value-based competition will have truly emerged.”

Working toward that goal are six pilot projects being conducted by the Ambulatory Care Quality Alliance (AQA), Mr. Leavitt said. Supported by the Centers for Medicare and Medicaid Services and the Agency for Health Care Research and Quality (AHRQ), the pilot projects are testing approaches to aggregating and reporting both public and private data on physician performance. According to AQA, the programs “will not only measure quality, but will identify those high quality providers who are able to deliver efficient care to patients, avoiding unnecessary complications and cost.”

Dr. Carolyn Clancy, AHRQ director, expanded on the purpose of the projects. “These pilots will begin to pave the way for showing how we can use the same set of measures … to try to figure out how can we report publicly on performance and, at least as important although probably not as rapidly, how do we get that information back to providers so they can improve.” She added that other sites would be added to the project shortly.

“We expect that when completed, the knowledge we develop through the AQA pilots will provide a comprehensive national framework for performance measurement and public reporting,” she said.

Although measurement will be conducted locally, Dr. Clancy said, it will still be important to have one set of measures used nationally. “If we're competing on different types of measures, we're not going to make any progress,” she said.

AQA is a national coalition of 125 physician, consumer, business, insurer, and government organizations that are working to develop strategies for measuring, reporting, and improving performance at the physician level. The group developed a “starter set” of 26 standard performance measures last year that AQA says is “now being incorporated in physician contracts and implemented around the country.” Measurements for hospital care are being developed by the Hospital Quality Alliance.

Mr. Leavitt said that, in addition to those two national alliances, he knows of 29 community-based quality measurement efforts, driven not only by businesses but also by physicians.

“The force that I believe must drive quality will be those who provide it, and the force that I have seen learning to measure quality [is] the physicians,” he said. “This cannot simply be the MBAs ganging up on the MDs. This has got to be a collaborative effort because in every case where quality has been measured by one side without the other, it's been ineffective and less efficient.”

Measuring quality is a key component of the Bush administration's policy to increase transparency and value in health care purchasing and delivery. The policy requires federal health care purchasers, including Medicare, Medicaid, and the Department of Veterans Affairs, to encourage the use of health information technology, share information about procedure prices, develop quality of care measures, and develop and identify approaches that facilitate high quality and efficient care.

Part of the effort is to define “episodes of care” for frequent procedures that can be used as units by which to compare costs among providers.

“The important thing is that insurance companies and larger payers like the government are able to present their information in a form that the data can, in a privacy- protected way, be assembled into episodes of care for comparison,” Mr. Leavitt said. “What is a hip replacement? What expense ought to be put into that bucket so we can compare one hospital or one physician to another?”

Mr. Leavitt and Dr. Clancy said the Bush administration's goal is to merge the insurance market power of the federal government with that of the private sector to move value-based competition along.

“During the next several months, we're going to see a tremendous push to combine the purchasing clout of the federal government with the health care buying power of the top 100 private employers in America—a public- private partnership on a scale we've never seen before to help health care consumers make more informed decisions about health care,” Dr. Clancy said.

WASHINGTON — Schemes measuring the quality of health care services against price will emerge in some local markets for several procedures in the next 2 years, Secretary of Health and Human Services Mike Leavitt said at a meeting on health information technology sponsored by eHealth Initiative and Bridges to Excellence.

Within 5 years, Mr. Leavitt said, the term “value” will become part of the health care lexicon. “Within 10 years, value-based competition will have truly emerged.”

Working toward that goal are six pilot projects being conducted by the Ambulatory Care Quality Alliance (AQA), Mr. Leavitt said. Supported by the Centers for Medicare and Medicaid Services and the Agency for Health Care Research and Quality (AHRQ), the pilot projects are testing approaches to aggregating and reporting both public and private data on physician performance. According to AQA, the programs “will not only measure quality, but will identify those high quality providers who are able to deliver efficient care to patients, avoiding unnecessary complications and cost.”

Dr. Carolyn Clancy, AHRQ director, expanded on the purpose of the projects. “These pilots will begin to pave the way for showing how we can use the same set of measures … to try to figure out how can we report publicly on performance and, at least as important although probably not as rapidly, how do we get that information back to providers so they can improve.” She added that other sites would be added to the project shortly.

“We expect that when completed, the knowledge we develop through the AQA pilots will provide a comprehensive national framework for performance measurement and public reporting,” she said.

Although measurement will be conducted locally, Dr. Clancy said, it will still be important to have one set of measures used nationally. “If we're competing on different types of measures, we're not going to make any progress,” she said.

AQA is a national coalition of 125 physician, consumer, business, insurer, and government organizations that are working to develop strategies for measuring, reporting, and improving performance at the physician level. The group developed a “starter set” of 26 standard performance measures last year that AQA says is “now being incorporated in physician contracts and implemented around the country.” Measurements for hospital care are being developed by the Hospital Quality Alliance.

Mr. Leavitt said that, in addition to those two national alliances, he knows of 29 community-based quality measurement efforts, driven not only by businesses but also by physicians.

“The force that I believe must drive quality will be those who provide it, and the force that I have seen learning to measure quality [is] the physicians,” he said. “This cannot simply be the MBAs ganging up on the MDs. This has got to be a collaborative effort because in every case where quality has been measured by one side without the other, it's been ineffective and less efficient.”

Measuring quality is a key component of the Bush administration's policy to increase transparency and value in health care purchasing and delivery. The policy requires federal health care purchasers, including Medicare, Medicaid, and the Department of Veterans Affairs, to encourage the use of health information technology, share information about procedure prices, develop quality of care measures, and develop and identify approaches that facilitate high quality and efficient care.

Part of the effort is to define “episodes of care” for frequent procedures that can be used as units by which to compare costs among providers.

“The important thing is that insurance companies and larger payers like the government are able to present their information in a form that the data can, in a privacy- protected way, be assembled into episodes of care for comparison,” Mr. Leavitt said. “What is a hip replacement? What expense ought to be put into that bucket so we can compare one hospital or one physician to another?”

Mr. Leavitt and Dr. Clancy said the Bush administration's goal is to merge the insurance market power of the federal government with that of the private sector to move value-based competition along.

“During the next several months, we're going to see a tremendous push to combine the purchasing clout of the federal government with the health care buying power of the top 100 private employers in America—a public- private partnership on a scale we've never seen before to help health care consumers make more informed decisions about health care,” Dr. Clancy said.

Affordable health care coverage should be public policy established in law with a set of core benefits available to all Americans by 2012, the Citizens' Health Care Working Group said in its interim recommendations.

Benefits would be defined by an independent, nonpartisan, public-private group and cover physical, mental, and dental health services, the panel recommended.

The working group was established by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to foster national debate on health services availability and financing. The final recommendations, expected early next year, will be sent to Congress and the White House for debate and consideration.

In developing its recommendations, the 14-member panel held public meetings throughout the country, conducted polls, and read nearly 5,000 individual commentaries.

New revenues would be required for the coverage, with the group suggesting use of dedicated revenue streams including enrollee contributions, income taxes or surcharges, “sin taxes,” payroll taxes, and value-added taxes.

“The opinion polls we examined, the community meetings we held, and the Web-based survey and comments we receive all showed large majorities of people willing to make additional financial investments in the service of expanding the protection against the costs of illness and the expansion of access to quality care,” the working group said in its report.

Paul B. Ginsburg, president of the Center for Studying Health System Change, praised the panel for pointing out that universal health coverage would require new revenues. “That's a reality check that almost no public leader is willing to admit because they always tells us you can do it for nothing.”

He added that although Congress and the administration are not in the mood for another major health care expansion, the recommendations could act as a “motivational paper” to alert lawmakers to the public's values.

The working group also recommended greater federal support of integrated community health networks through establishment of a specific unit with responsibility for coordinating all federal efforts regarding the health care safety net.

Efforts to improve quality and efficiency of care should be strengthened by the federal government through use of existing public health care programs and promotion of health information technology and electronic medical records, especially in underserved areas, the working group's report said.

The report also suggested that end-of-life services financing and provisions should be restructured “so that people living with advanced incurable conditions have increased access to these services in the environment they choose.”

Working group members represent consumers, the uninsured, benefits financing, business, labor, and health care providers. It is chaired by Randall L. Johnson, director of human resource strategies for Motorola. The legislative provision that created the working group was sponsored by Senator Orrin Hatch (R-Utah) and Senator Ron Wyden (D-Ore.).

Affordable health care coverage should be public policy established in law with a set of core benefits available to all Americans by 2012, the Citizens' Health Care Working Group said in its interim recommendations.

Benefits would be defined by an independent, nonpartisan, public-private group and cover physical, mental, and dental health services, the panel recommended.

The working group was established by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to foster national debate on health services availability and financing. The final recommendations, expected early next year, will be sent to Congress and the White House for debate and consideration.

In developing its recommendations, the 14-member panel held public meetings throughout the country, conducted polls, and read nearly 5,000 individual commentaries.

New revenues would be required for the coverage, with the group suggesting use of dedicated revenue streams including enrollee contributions, income taxes or surcharges, “sin taxes,” payroll taxes, and value-added taxes.

“The opinion polls we examined, the community meetings we held, and the Web-based survey and comments we receive all showed large majorities of people willing to make additional financial investments in the service of expanding the protection against the costs of illness and the expansion of access to quality care,” the working group said in its report.

Paul B. Ginsburg, president of the Center for Studying Health System Change, praised the panel for pointing out that universal health coverage would require new revenues. “That's a reality check that almost no public leader is willing to admit because they always tells us you can do it for nothing.”

He added that although Congress and the administration are not in the mood for another major health care expansion, the recommendations could act as a “motivational paper” to alert lawmakers to the public's values.

The working group also recommended greater federal support of integrated community health networks through establishment of a specific unit with responsibility for coordinating all federal efforts regarding the health care safety net.

Efforts to improve quality and efficiency of care should be strengthened by the federal government through use of existing public health care programs and promotion of health information technology and electronic medical records, especially in underserved areas, the working group's report said.

The report also suggested that end-of-life services financing and provisions should be restructured “so that people living with advanced incurable conditions have increased access to these services in the environment they choose.”

Working group members represent consumers, the uninsured, benefits financing, business, labor, and health care providers. It is chaired by Randall L. Johnson, director of human resource strategies for Motorola. The legislative provision that created the working group was sponsored by Senator Orrin Hatch (R-Utah) and Senator Ron Wyden (D-Ore.).

Affordable health care coverage should be public policy established in law with a set of core benefits available to all Americans by 2012, the Citizens' Health Care Working Group said in its interim recommendations.

Benefits would be defined by an independent, nonpartisan, public-private group and cover physical, mental, and dental health services, the panel recommended.

The working group was established by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to foster national debate on health services availability and financing. The final recommendations, expected early next year, will be sent to Congress and the White House for debate and consideration.

In developing its recommendations, the 14-member panel held public meetings throughout the country, conducted polls, and read nearly 5,000 individual commentaries.

New revenues would be required for the coverage, with the group suggesting use of dedicated revenue streams including enrollee contributions, income taxes or surcharges, “sin taxes,” payroll taxes, and value-added taxes.

“The opinion polls we examined, the community meetings we held, and the Web-based survey and comments we receive all showed large majorities of people willing to make additional financial investments in the service of expanding the protection against the costs of illness and the expansion of access to quality care,” the working group said in its report.

Paul B. Ginsburg, president of the Center for Studying Health System Change, praised the panel for pointing out that universal health coverage would require new revenues. “That's a reality check that almost no public leader is willing to admit because they always tells us you can do it for nothing.”

He added that although Congress and the administration are not in the mood for another major health care expansion, the recommendations could act as a “motivational paper” to alert lawmakers to the public's values.

The working group also recommended greater federal support of integrated community health networks through establishment of a specific unit with responsibility for coordinating all federal efforts regarding the health care safety net.

Efforts to improve quality and efficiency of care should be strengthened by the federal government through use of existing public health care programs and promotion of health information technology and electronic medical records, especially in underserved areas, the working group's report said.

The report also suggested that end-of-life services financing and provisions should be restructured “so that people living with advanced incurable conditions have increased access to these services in the environment they choose.”

Working group members represent consumers, the uninsured, benefits financing, business, labor, and health care providers. It is chaired by Randall L. Johnson, director of human resource strategies for Motorola. The legislative provision that created the working group was sponsored by Senator Orrin Hatch (R-Utah) and Senator Ron Wyden (D-Ore.).

Affordable health care coverage should be public policy established in law with a set of core benefits available to all Americans by 2012, the Citizens' Health Care Working Group said in its interim recommendations.

Benefits would be defined by an independent, nonpartisan, public-private group and encompass physical, mental, and dental health services, the panel suggested.

The working group was established by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to foster national debate on health services availability and financing. Final recommendations, expected early next year, will be sent to Congress and the White House for further debate and consideration.

In developing its recommendations, the 14-member panel held public meetings across the country, conducted polls, and read almost 5,000 individual commentaries.

New revenues would be required for the coverage, with the group suggesting use of dedicated revenue streams including enrollee contributions, income taxes or surcharges, "sin taxes," payroll taxes, and value-added taxes.

"The opinion polls, the community meetings, and the Web-based survey and comments all showed large majorities of people willing to make additional financial investments in the service of expanding the protection against the costs of illness and the expansion of access to quality care," the working group said in its report.

Paul B. Ginsburg, president of the Center for Studying Health System Change, praised the panel for pointing out that universal health coverage would require new revenues. "That's a reality check that almost no public leader is willing to admit because they always tells us you can do it for nothing."

He said although Congress and the administration are not keen on another major health care expansion, the recommendations could act as a "motivational paper" to alert lawmakers to the public's values.

The working group also recommended greater federal support of integrated community health networks through establishment of a specific unit with responsibility for coordinating all federal efforts regarding the health care safety net.

Efforts to improve quality and efficiency of care should be strengthened by the federal government through use of existing public health care programs and promotion of health information technology and electronic medical records, especially in underserved areas, the report said.

The report also suggested that end-of-life services financing and provisions should be restructured "so that people living with advanced incurable conditions have increased access to these services in the environment they choose."

Working group members represent consumers, the uninsured, benefits financing, business, labor, and health care providers. It is chaired by Randall L. Johnson, director of human resource strategies for Motorola. The legislative provision that created the working group was sponsored by Senator Orrin Hatch (R-Utah) and Senator Ron Wyden (D-Ore.).

Affordable health care coverage should be public policy established in law with a set of core benefits available to all Americans by 2012, the Citizens' Health Care Working Group said in its interim recommendations.

Benefits would be defined by an independent, nonpartisan, public-private group and encompass physical, mental, and dental health services, the panel suggested.

The working group was established by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to foster national debate on health services availability and financing. Final recommendations, expected early next year, will be sent to Congress and the White House for further debate and consideration.

In developing its recommendations, the 14-member panel held public meetings across the country, conducted polls, and read almost 5,000 individual commentaries.

New revenues would be required for the coverage, with the group suggesting use of dedicated revenue streams including enrollee contributions, income taxes or surcharges, "sin taxes," payroll taxes, and value-added taxes.

"The opinion polls, the community meetings, and the Web-based survey and comments all showed large majorities of people willing to make additional financial investments in the service of expanding the protection against the costs of illness and the expansion of access to quality care," the working group said in its report.

Paul B. Ginsburg, president of the Center for Studying Health System Change, praised the panel for pointing out that universal health coverage would require new revenues. "That's a reality check that almost no public leader is willing to admit because they always tells us you can do it for nothing."

He said although Congress and the administration are not keen on another major health care expansion, the recommendations could act as a "motivational paper" to alert lawmakers to the public's values.

The working group also recommended greater federal support of integrated community health networks through establishment of a specific unit with responsibility for coordinating all federal efforts regarding the health care safety net.

Efforts to improve quality and efficiency of care should be strengthened by the federal government through use of existing public health care programs and promotion of health information technology and electronic medical records, especially in underserved areas, the report said.

The report also suggested that end-of-life services financing and provisions should be restructured "so that people living with advanced incurable conditions have increased access to these services in the environment they choose."

Working group members represent consumers, the uninsured, benefits financing, business, labor, and health care providers. It is chaired by Randall L. Johnson, director of human resource strategies for Motorola. The legislative provision that created the working group was sponsored by Senator Orrin Hatch (R-Utah) and Senator Ron Wyden (D-Ore.).

Affordable health care coverage should be public policy established in law with a set of core benefits available to all Americans by 2012, the Citizens' Health Care Working Group said in its interim recommendations.

Benefits would be defined by an independent, nonpartisan, public-private group and encompass physical, mental, and dental health services, the panel suggested.

The working group was established by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to foster national debate on health services availability and financing. Final recommendations, expected early next year, will be sent to Congress and the White House for further debate and consideration.

In developing its recommendations, the 14-member panel held public meetings across the country, conducted polls, and read almost 5,000 individual commentaries.

New revenues would be required for the coverage, with the group suggesting use of dedicated revenue streams including enrollee contributions, income taxes or surcharges, "sin taxes," payroll taxes, and value-added taxes.

"The opinion polls, the community meetings, and the Web-based survey and comments all showed large majorities of people willing to make additional financial investments in the service of expanding the protection against the costs of illness and the expansion of access to quality care," the working group said in its report.

Paul B. Ginsburg, president of the Center for Studying Health System Change, praised the panel for pointing out that universal health coverage would require new revenues. "That's a reality check that almost no public leader is willing to admit because they always tells us you can do it for nothing."

He said although Congress and the administration are not keen on another major health care expansion, the recommendations could act as a "motivational paper" to alert lawmakers to the public's values.

The working group also recommended greater federal support of integrated community health networks through establishment of a specific unit with responsibility for coordinating all federal efforts regarding the health care safety net.

Efforts to improve quality and efficiency of care should be strengthened by the federal government through use of existing public health care programs and promotion of health information technology and electronic medical records, especially in underserved areas, the report said.

The report also suggested that end-of-life services financing and provisions should be restructured "so that people living with advanced incurable conditions have increased access to these services in the environment they choose."

Working group members represent consumers, the uninsured, benefits financing, business, labor, and health care providers. It is chaired by Randall L. Johnson, director of human resource strategies for Motorola. The legislative provision that created the working group was sponsored by Senator Orrin Hatch (R-Utah) and Senator Ron Wyden (D-Ore.).