cern is that without a mechanism in place for continuously evaluating the impact of performance measurement initiatives and guarding against unintended consequences, the much-needed evidence base for identifying effective interventions will be less likely to evolve.


In the above context, the committee considered four alternatives for achieving a high-functioning national system for performance measurement and reporting, as illustrated in Figure 2-1 in Chapter 2: (1) establishing a large federal entity, (2) establishing an office within CMS or the Agency for Healthcare Research and Quality (AHRQ), (3) delegating functions to existing stakeholder groups, and (4) establishing a new independent board.

Alternative 1: Large Federal Entity

A new federal entity could be established to assume responsibility for the entire spectrum of activities shown in Figure 2-1 in Chapter 2. The advantage of this option is that all of the resources needed to create a national system for performance measurement and reporting would be housed under one roof and supported by a single stream of funding. However, the committee believes this option is not preferable for several reasons. First, creating such a federal entity would duplicate the work already being performed by a host of reputable stakeholder groups. Incurring the high cost of assuming the tasks currently conducted by those existing groups would be imprudent, particularly in the current fiscal environment. Moreover, the transition to a large federal bureaucracy could disrupt current activities in the private sector, thus having the unintended consequence of setting back progress made to date that has been shown to be of value.

Alternative 2: Office Within the Centers for Medicare and Medicaid Services or the Agency for Healthcare Research and Quality

Current public–private, largely voluntary efforts could be sustained with the addition of a special office within CMS or AHRQ that would be charged with encouraging existing players to align those efforts more directly with a specific set of national health goals. The committee believes this option would be an improvement over the status quo, but lacks the capacity to achieve the vision of a full-fledged national system for performance measurement and reporting. The committee believes such an office would be unlikely to have the authority to establish national goals and aims for improvement, and would lack the clout and the resources to convince stakeholder groups to move beyond the sphere of their own special interests.

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