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GAO Report Highlights Problems with HHS Oversight of Quality Measure Development

January 20, 2012—The Government Accountability Office (GAO) Jan. 13 released a report assessing the Department of Health and Human Services (HHS) oversight of the quality measure development process. The report, mandated under the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA, P. L. 110-275), found that HHS has failed to establish a comprehensive plan to identify and prioritize measures and timeframes as specified under the Affordable Care Act (ACA, P.L. 111-148 and P.L. 111-152). This lack of progress may have an impact on the performance-based payment programs mandated by the ACA that require the use of these quality measures. 

The GAO report also concluded that the National Quality Forum (NQF), a consensus-based entity of health experts tasked with developing national standards of quality measurement, was unable to meet the required timeframes on several projects assigned by HHS. The NQF was selected by HHS to perform many of the measurement related requirements specified under the ACA.

The GAO looked at two key criteria in its report:

  • The status of projects under NQF’s required contract activities; and
  • The extent to which HHS used or planned to use the measures it received from NQF under the contract to meet its quality measurement needs, as of August 2011.

The GAO found that the NQF finished or made progress on 60 of the 63 projects in their contract with HHS. The organization completed 26 projects, but failed to meet established deadlines on 18 of them. Additionally, the NQF was not expected to meet the required timeframes on 14 projects that currently are being conducted by HHS. Specifically, NQF was expected to meet time frames for projects relating to the retooling of 113 endorsed quality measures into an electronic format by January 2011. These measures were not reviewed until June 2011. According to GAO, HHS compounded these delays by failing to effectively monitor the status of the NQF projects. HHS neglected to conduct an annual review of the project’s timeliness and cost, and neglected to take action when the agency did not receive monthly financial reports, as required under the contract.

The GAO concluded that HHS should utilize all of the monitoring tools available under its contract to aptly assess NQF’s performance. The GAO also recommended that HHS should complete testing of all retooled measures and develop a comprehensive plan for its quality measurement needs.


Scott Wetzel, M.P.P.
Lead, Quality Reporting
Telephone: 202-828-0495


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