cation, and organizational and systems capacity building. The Secretary should also direct CMS to require that providers submit to the NQCB (or its designee) performance data that can be used by Medicare for public reporting and quality improvement activities or as a basis for payment. In addition, Congress should activate an interagency task force to explore mechanisms for aligning other government health care programs with these efforts—including the Department of Defense (DoD) TRICARE program and DoD-operated clinical facilities, the Federal Employees Health Benefits Program, and the programs of the Veterans Health Administration and the Indian Health Service.

  • Financial strength. The NQCB should have sufficient, stable funding to contract for services with outside groups and organizations so it can perform its designated functions effectively. The board should be funded directly from the Medicare Trust Fund and have bypass authority to request an appropriation directly from Congress. This bypass authority would free the NQCB from the unpredictable budgetary cycles commonly associated with preparing discretionary budgets that are subject to review and modification on the basis of other departmental, executive, and legislative priorities. Congress should authorize and appropriate funds to support the work of the NQCB and to implement its recommendations in Medicare and other government programs by the end of fiscal year 2007. More specifically, Congress should authorize an annual allocation from the Medicare Trust Fund, initially in the range of $100–200 million. This level of investment is based on an analysis of resources that currently support related but more limited activities within the National Quality Forum, the National Committee for Quality Assurance, and the Joint Commission on Accreditation of Healthcare Organizations. This figure constitutes approximately 0.1 percent of the Medicare annual budget,1 a relatively small investment with great potential to enhance value and improve efficiency throughout the health care delivery system. The committee envisions substantial staff requirements to support the functions of the board delineated in Recommendation 1 and substantial costs related to contracts with existing entities to carry out tasks pursuant to the mission of the board. Although the federal government should provide up front the funding needed for the NQCB to become fully operational, particularly with regard to its public-good functions, public–private partnerships could be formed over time to support this ongoing work.

  • External accountability. The NQCB should be required to provide an annual report to Congress on its progress toward implementing an effective quality measurement and reporting system. In addition, the board


$278 billion in 2003 (CMS, 2004).

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