ACP: AQA (Formerly known as Ambulatory Care Quality Alliance)

Running a Practice

AQA (Formerly known as Ambulatory Care Quality Alliance)

In September 2004, the the American College of Physicians, American Academy of Family Physicians (AAFP), America's Health Insurance Plans (AHIP), and the Agency for Healthcare Research and Quality (AHRQ), joined together to lead a collaborative effort for determining, under the most expedient timeframe, how to most effectively and efficiently improve performance measurement, data aggregation and reporting in the ambulatory care setting. ACP recognized that the proliferation of performance measures in Medicare and among health plans will have a major impact on internists’ reimbursement and practice operations.

AQA is a national consortium of organizations including ACP and other physician organizations; employers; government agencies, such as the Agency for Healthcare Research and Quality (AHRQ) and the Centers for Medicare and Medicaid Services (CMS); health insurance plans, including AHIP; consumers, and accrediting organizations. AQA was organized to "improve health care quality and patient safety through a collaborative process in which key stakeholders agree on a strategy for measuring reporting and improving performance at the physician level."

Clinical measures "starter set"

In May 2005 AQA agreed upon a "starter set" of 26 clinical performance measures for the IOM's top-20 conditions in the ambulatory care setting. The initial set of measures will rely principally on administrative data that is readily available for most practices, thereby reducing the administrative burden of having to extract information from medical records. In addition, the College ensured that the starter set met its standards for scientific validity, feasibility, and relevance to physicians, patients and purchasers.

The starter set measures were developed by either the NCQA or the AMA Physician’s Consortium on Performance Improvement (PCPI). These two organizations routinely review and revise their performance measures as new research and experience warrants.

Most of the measures have been endorsed by the National Quality Forum, and the remaining are currently under review for potential future endorsement. ACP worked to ensure that the starter set measures met our standards for scientific validity, feasibility and relevance to physicians, patients and purchasers.

The uniform starter set of measures could be available to be incorporated into health care payor contracts as early as January 2006. The starter set includes prevention measures for cancer screening and vaccinations, measures for chronic conditions including coronary artery disease, heart failure, diabetes, and asthma, depression, prenatal care, and two efficiency measures that address overuse and misuse.

The measurement set will be expanded over time through review of proposed measures from the organizations listed above and by reviewing measures (e.g., efficiency measures) proposed by payer groups. It will also be expanded by adding measures for subspecialty medicine and surgical conditions. The expectation of the large coalition involved in the AQA is that all payers, including CMS, will select measures from the approved set to reduce the practice hassles of reporting on different measures to different payers.

AQA also is working on a model for aggregating and sharing data to maintain appropriate restrictions on privacy and confidentiality and principles for reporting information to providers, consumer and purchasers.

Broad stakeholder support

Broad stakeholder support means that internists will not have to deal with conflicting or duplicative measures that are not scientifically valid or that would impose excess administrative burdens. A broad range of stakeholders have participated in AQA meeting and/or workgroup discussions:

Physicians, hospitals and other health care professionals include: ACP, AAFP, the American Medical Association (AMA), the AMA Physician Consortium for Performance Improvement, the American Board of Internal Medicine, the American Board of Medical Specialties, the American College of Cardiology, the American Academy of Pediatrics, the American Academy of Allergy, Asthma and Immunology, the American Osteopathic Association, and the American Hospital Association.
Private sector employers, business coalitions and consumers include: AARP, Consumer/Purchaser Disclosure Project, The Leapfrog Group, the National Business Group on Health, the National Business Coalition on Health, the Pacific Business Group on Health, Motorola, UPS, BellSouth, Xerox, and Marriott.
Public purchasers and other government agencies include: CMS, OPM, AHRQ, and the Department of Treasury.
Health insurance plans include: Aetna, Cigna, Health Net, Health Partners, Humana, Independence BCBS, Pacificare, UnitedHealth Group, Wellchoice, Wellpoint, AHIP, Blue Cross Blue Shield Association.
Accrediting organizations include: NCQA, JCAHO, and URAC.

Continued leadership in and support of the AQA will enable ACP to influence future measures, guidelines on use of measures for reporting, and reimbursement.

View the AQA's Web site.