• Gaps in performance measurement, such as the capacity to measure equity and access, are unlikely to be filled because of the lack of clear ownership of these aspects of the nation’s quality improvement agenda.

  • Wasteful duplication and inconsistencies among measures will continue, since no single stakeholder group has the standing to require others to use specific, standardized definitions and measurements.

  • Measures may not be viewed as authoritative, credible, or objective since the measures developed by most stakeholders are more apt to reflect the interests of their constituencies than those of others.

  • Public goods, such as investments in better risk adjustment methodologies and data aggregation methods, are unlikely to be addressed adequately in a competitive market among current developers of measures.

  • Making all information fully transparent and available to the public is unlikely, since much of the technology and data on performance measurement is currently held as proprietary.

Table 3-1 provides a synopsis of the four alternatives discussed above. Although a large federal entity could assume all the necessary functions for a national performance measurement and reporting system, the committee

TABLE 3-1 Comparison of Alternatives for Achieving a National System for Performance Measurement and Reporting

Key Functions of a National System

Alternative 1: Large Federal Entity

Alternative 2: Office Within CMS or AHRQ

Alternative 3: Other Stakeholder Groups

Alternative 4: Independent Board

Specify purpose and aims


Prioritize national goals

Promulgate standardized measures

Ensure data collection, validation, and aggregation

Establish public reporting methods responsive to the needs of all stakeholders

Identify a research agenda


Evaluate impact of overall system

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