gram but will have several different emphases. It will focus far more directly on quality assurance, it will cover all major settings of care, and it will emphasize both a wide range of patient outcomes and the process of care. It will also have a greatly expanded program evaluation component and greater public oversight and accountability. These new emphases present extraordinary challenges.

We advance 10 recommendations to support our proposed program. The first two change the mission of Medicare to include explicit goals for assuring the quality of care for Medicare enrollees, in accordance with this committee’s definition of quality of care.

Three recommendations establish the MPAQ, MQROs, and two advisory bodies, namely the QualPAC for Congress and the National Council on Medicare Quality Assurance for the Secretary of DHHS. A related recommendation directs the Secretary of DHHS to report periodically to Congress on the quality of care for Medicare beneficiaries and the impact of the new MPAQ program on that care. Another recommendation calls for a program to improve both the accreditation and the certification procedures related to Medicare Conditions of Participation.

Two recommendations call for the Secretary of DHHS to support and expand research and educational activities designed to improve the nation’s knowledge base and capacity for quality assurance. The final recommendation asks that Congress authorize and appropriate the necessary funds to implement all the preceding recommendations.

We also outline a strategy to implement the MPAQ over a 10-year span. Phase I would establish the MPAQ and its adjuncts, institute key program planning and evaluation activities, review PRO program activities, institute changes in hospital Conditions of Participation procedures at HCFA, and begin broad research and capacity building activities across the Department.

Phase II would focus on design, testing, and implementation of data collection, data analysis, and information dissemination mechanisms. It would also include special projects on four issues: distinguishing providers on the basis of quality and patient outcomes; improving the average level of performance; providing incentives for good and exemplary performance; and dealing with outliers.

In Phase III, tasks begun in Phases I and II would be completed and full implementation of the MPAQ would begin. In addition, four issues of special long-range concern would be addressed. Two of these involve the MPAQ directly, namely, public oversight and accountability and program evaluation. The third and fourth are research and capacity building, which encompass issues well beyond the implementation of the Medicare quality assurance program and hence involve policy issues for all of DHHS.

The MPAQ strategy outlined in this chapter is skeletal, yet very ambitious. We made our recommendations aware that the system of care in the

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