Healthcare quality measures are essential for ensuring that physicians and care organizations are providing patients with high-quality treatment for a myriad of health issues. Despite its prevalence, there is a striking lack of quality measures for the assessment, treatment, and outcomes of obesity care. Dr. Tracy Zvenyach of the Obesity Action Coalition and I published an assessment of obesity quality measures in Current Obesity Reports. In this letter we describe the importance of quality measures and their development.
Several organizations are involved in the development and use of quality measures. The National Committee for Quality Assurance (NCQA) develops measures for healthcare providers. The Centers for Medicare and Medicaid Services (CMS) also develops measures with other organizations and uses them for performance improvement and promoting patient perspectives. Aside from measure development, the National Quality Forum (NQF) endorses quality measures after the development process. The NQF endorsement is preferred by measure developers but is not required for measures to be implemented. After development and possible endorsement, measures are implemented and adopted by Medicare, Medicaid, and other insurance plans, where they are used to collect data for reporting on healthcare delivery. The following figure highlights how measures are developed and the essential role that stakeholders play in the process.
Source: Zvenyach & Dietz, 2023
Quality measures play an important role in healthcare because they are used to assess and improve outcomes, inform consumers, and influence payment. Measures are classified into three different types to evaluate different aspects of healthcare delivery. The first type is structural measures which indicate the capacity of systems in place in healthcare delivery (e.g.. provider-to-patient ratio). The second type is process measures, which indicate actions related to patient care (i.e. percentage of people with diabetes who had a blood sugar test). The third measure assesses outcome, and is used to determine the impact of care on patient outcomes (e.g.. hospital-acquired infection rates). Outcome measures are preferred because they capture the consequences of healthcare services and reflect the outcome of care.
Few measures relating to obesity are currently included in reporting and payment programs. The development and implementation of obesity-related outcome measures will be essential for evaluating and improving the quality of comprehensive obesity care that patients receive. Quality measures of obesity that have been previously developed and implemented have all been process measures; patient outcomes have never been central to obesity quality assurance. CMS uses an adult obesity measure entitled “Preventative Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan” which measures the percentage of patients with a documented plan for BMI management. However, the measure was previously adopted by NQF, which removed its endorsement in 2020. Another measure, “Adult BMI Assessment,” from the NCQA was retired in 2020. One pediatric obesity quality measure used by CMS entitled “Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents” only measures the prevalence of counseling by providers, not the quality or impact of the counseling. This pediatric measure and the adult preventive care screening measure are the only two obesity measures currently implemented within payment programs.
Several organizations have begun to address this gap in quality measurements of obesity. The American Medical Group Association (AMGA) Obesity Care Model Collaborative (OCMC) has tested seven measures, ranging from operations to patient outcomes, and found that all were feasible and valuable. An obesity diagnosis measure was judged as the measure with the greatest potential for implementation. Additionally, the Minnesota Community Measurement (MCM) and the Endocrine Society (ES) are actively testing four new measures with reporting expected at the end of this year.
The Current Obesity Reports paper concludes with a suggestion for the development of five measures to ensure quality measures at every step of obesity care. These include diagnosis of obesity, assessment of comorbidities, implementation of evidence-based therapy, patient response to therapy, and patient-reported quality of life. The development of these measures will take time and investment but ultimately are essential to address the care offered for a chronic disease that impacts 42% of adults in the United States.