Performance Measurement in the Hospital Outpatient Setting

Table of Contents

PREFACE
TABLE OF FIGURES
TABLE OF TABLES
EXECUTIVE SUMMARY
ACKNOWLEDGEMENTS
GLOSSARY OF ABBREVIATIONS
I. INTRODUCTION
   Background
   Purpose of this Study
II. ANALYTIC FRAMEWORK AND METHODS
   Defining the Hospital Outpatient Setting
   Methods
   Analysis of Medicare Hospital Outpatient Data
   Scan of Existing Measures
   Discussions with Medical Specialty Societies and Hospital Associations
   Synthesis of Findings from Environmental Scan
III. FINDINGS FROM THE ENVIRONMENTAL SCAN
   Findings from Analysis of Medicare Data
   Overall Findings
   Common Reasons for Visits in the Hospital Outpatient Setting and Emergency Department
   Most Commonly Provided Services/Procedures and Associated Diagnoses in the Hospital Outpatient Setting and Emergency Department
   Services/Procedures and Associated Diagnoses Representing the Largest Share of Costs in the Hospital Outpatient Setting and Emergency Department
   Most Frequent Used Drugs and Biologicals in the Hospital Outpatient Setting and Emergency Department
   Findings from the Scan of Existing Measures and Discussions
   Existing Measures
   Measures in the Development Pipeline
   Measures that Are Lacking
IV. SYNTHESIS OF EXISTING MEASURES AND IDENTIFICATION OF GAPS
Mapping of Clinical Measures
Syntheses of Measures
Synthesis of Measures Relating to Reasons for Visits
Synthesis of Measures Relating to Services/Procedures
Synthesis of Measures Relating to Drugs and Biologicals
Identification of Gaps in Measures
Effectiveness
Efficiency
Equity
Patient-Centeredness
Safety
Timeliness
Challenges in Performance Measurement
V. CONCLUSIONS
Study Limitations and Considerations for Future Analysis and Measurement Development
Next Steps for Consideration
APPENDIX A: ADDITIONAL MEASURES UNDER CONSIDERATION FOR INCLUSION IN HOSPITAL OUTPATIENT QUALITY DATA REPORTING PROGRAM (HOP QDRP) 65
APPENDIX B: LIST OF ORGANIZATIONS INCLUDED IN ENVIRONMENTAL SCAN DISCUSSIONS
APPENDIX C: DIAGNOSES ASSOCIATED WITH VISITS TO HOSPITAL OUTPATIENT AND EMERGENCY DEPARTMENTS BY MEDICARE BENEFICIARIES, 2005 \
APPENDIX D: MEASURES POTENTIALLY RELEVANT TO THE HOSPITAL OUTPATIENT SETTING AND EMERGENCY DEPARTMENT
APPENDIX E: DESCRIPTION OF PRIMARY DEVELOPERS OF CANDIDATE MEASURES
REFERENCES

TABLE OF FIGURES

Figure 1.1: Spending on All Hospital Outpatient Services, 1996-2006 (MedPAC 2007)
Figure 1.2: Annual Growth in the Number of Medicare Outpatient Services (MedPAC 2007)
Figure 2.1. Framework Used in this Study
Figure 3.1: HOPS Visits by Clinical Category, 2005
Figure 3.2: ED Visits by Clinical Category, 2005
Figure 4.1. Mapping of Reasons for Visits to Existing Clinical Measures

TABLE OF TABLES

Table 1.1. Medicare Hospital OPPS Volume of Services and Payments 2005, (MedPAC 2007b)
Table 1.2. Proposed Hospital Outpatient Measures for the Hospital Outpatient Quality Data Reporting Program (HOP QDRP)
Table 3.1. Volume and Expenditures Related to Visits and Services/Procedures in the Hospital Outpatient and Emergency Departments
Table 3.2. Diagnoses for Visits to HOPS and ED by Medicare Beneficiaries, 2005
Table 3.3. Most Common Services/Procedures in the HOPS and Associated Diagnoses, Medicare 2005
Table 3.4. Most Common Services/Procedures in the ED and Associated Diagnoses, Medicare 2005
Table 3.5. Services/Procedures Accounting for the Largest Fraction of Costs in the HOPS and Associated Diagnoses, Medicare 2005
Table 3.6. Services/Procedures Accounting for the Largest Fraction of Costs in the ED and Associated Diagnoses, Medicare 2005
Table 3.7. Top 50 Separately Billed Drugs/Biologicals in the HOPS and ED, Medicare 2005
Table 3.8 Summary of Clinical Areas Addressed by Measures Potentially Relevant to the Hospital Outpatient Setting and Emergency Department
Table 4.1. Diagnostic Categories Associated with Visits by Medicare Beneficiaries to the HOPS in 2005 and Existing Measures

back to top

How to Obtain a Printed Copy

To obtain a printed copy of this report, send the title and your mailing information to:

Health Policy, Room 447D
Assistant Secretary for Planning and Evaluation
U.S. Department of Health and Human Services
200 Independence Ave, SW
Washington, DC 20201

Fax:  (202) 690-6870

If you are interested in this, or any other ASPE product, please contact the Policy Information Center at (202) 690-6445. Or you may email us at pic@hhs.gov

---

Where to?

Top of Page

Home Pages:
Health Policy
Assistant Secretary for Planning and Evaluation (ASPE)
U.S. Department of Health and Human Services (HHS)

Last updated: 1/10/2008