Statewide Quality Advisory Committee (SQAC) Governing Statute (2012)

Statewide Advisory Committee on a Standard Quality Measure Set

Section 54 of Chapter 288 of the Acts of 2010 (as amended by Chapter 359)

The department of public health shall promulgate regulations under section 25P of chapter 111 of the General Laws by April 1, 2011requiring the uniform reporting of a standard set of health care quality measures for each health care provider facility, medical group, or provider group in the commonwealth hereinafter referred to as the "Standard Quality Measure Set."

The department of public health shall convene a statewide advisory committee which shall recommend to the department by January 1, 2011 the Standard Quality Measure Set.

The statewide advisory committee shall consist of the commissioner of health care finance and policy or the commissioner’s designee, and the commissioner of the department of public health or the commissioner’s designee, who shall serve as co-chairs; and up to 8 members, including the executive director of the group insurance commission and the Medicaid director, or the directors designees; and up to 6 representatives of organizations to be appointed by the governor including at least 1 representative from an acute care hospital or hospital association, 1 representative from a provider group or medical association or provider association, 1 representative from a medical group, 1 representative from a private health plan or health plan association, 1 representative from an employer association and 1 representative from a health care consumer group.

Members of the committee shall be appointed for terms of 2 years and shall serve until the term is completed or until a successor is appointed. Members shall be eligible to be reappointed and shall serve without compensation.

In developing its recommendation of the Standard Quality Measure Set, the advisory committee shall, after consulting with state and national organizations that monitor and develop quality and safety measures, select from existing quality measures and shall not select quality measures that are still in development or develop its own quality measures.

The committee shall annually recommend to the department of public health any updates to the Standard Quality Measure Set by November 1.

For its recommendation beginning in 2011, the committee may solicit for consideration and recommend other nationally recognized quality measures not yet developed or in use as of November 1, 2010, including recommendations from medical or provider specialty groups as to appropriate quality measures for that group’s specialty.

At a minimum, the Standard Quality Measure Set shall consist of the following quality measures: (i) the Centers for Medicare and Medicaid Services hospital process measures for acute myocardial infarction, congestive heart failure, pneumonia and surgical infection prevention; (ii) the Hospital Consumer Assessment of Healthcare Providers and Systems survey; (iii) the Healthcare Effectiveness Data and Information Set reported as individual measures and as a weighted aggregate of the individual measures by medical or provider group; and (iv) the Ambulatory Care Experiences Survey.


 

  Statewide Quality Advisory Committee (SQAC) Priorities (2012)

Given the breadth of the four statutorily mandated measure sets (HEDIS, CMS, ACES, and HCAHPS), and their concentration on measuring hospital and physician group performance, the first annual SQAC process will be focused on recommending measure prioritization among those sets for promulgation of regulations, followed by discussions of measurements within three priority areas identified by the Co-Chairs. In keeping with the advisory role of the SQAC, the Co-Chairs will define priorities primarily through the expressed needs of the Department and Division, but also with input from SQAC members and the public.

The year-one focus for the SQAC selection and evaluation process will be quality measures that will aid state government in measuring the performance of integrated healthcare systems, such as ICOs, ACOs, and PCMHs. The development of such systems is critical to the state goal of encouraging high-quality, coordinated, and affordable healthcare. The opportunity for the SQAC to assist in developing the means to measure the success of this initiative will support state efforts to monitor the transformation of the delivery system.

  • The following topics outline specific priority areas to be presented to the SQAC and that support the Committee’s mission.
    • Efficiency and system performance
      • Patient outcomes (results of care: mortality, complications, quality of life, etc.)
      • Appropriate care utilization (processes of care regarding overuse, underuse, and misuse: preventable hospitalizations, MRIs for low back pain, antibiotics for URIs, elective C-section before 39 weeks, etc.)

    • Care transitions and coordination
      • Utilization of care transition tools (INTERACT, [1] CTM-3 or CTM-5,[2] etc.)
      • Measures of coordinated care (such as timely access, readmissions, avoidable ED visits)

    • High-priority settings and clinical focus areas
      • Behavioral health
      • Post-acute care settings
      • Community and population health
      • Free standing and hospital outpatient surgical centers

[1]Interventions to Reduce Acute Care Transfers

[2] Care Transitions Measure-3 or Care Transitions Measure

Download SQAC Priorities (PDF) pdf format of priorities-final.pdf | Word doc format of priorities-final.doc

 

   Statewide Quality Advisory Committee (SQAC) Bylaws (2012)

This document serves to define a process by which the Committee will function, including but not limited to group process, identification, review and evaluation of candidate measures of quality, and prioritization of recommendations in an organized, efficient way that leads to the completion of a set of measures suited to the purposes of Chapter 288, Section 54 of the Acts of 2010.

Statutory Reference Chapter 288, §54 of the Acts of 2010

Chapter 288, §54 of the Acts of 2010, as amended by Chapter 359 of the Acts of 2010, establishes the Statewide Quality Advisory Committee (SQAC).  The SQAC will make recommendations that would require uniform reporting of a standard set of health care quality measures for health care providers, facilities and provider groups to be promulgated by the Department of Public Health (DPH).

The SQAC is co-chaired by the Commissioner of Public Health and the Commissioner of Health Care Finance and Policy.  The members of the Committee are appointed by the Governor and are as follows:

  • Executive Director of the Group Insurance Commission
  • Director of Medicaid Office
  • Representative from an acute care hospital or hospital association
  • Representative from a provider group, medical association or provider association
  • Representative from a medical group
  • Representative from a private healthcare plan or health plan association
  • Representative from an employer association
  • Representative from a health care consumer group
 The SQAC should examine existing quality measures and consult with experts as necessary. These quality measures must include:
  • CMS Hospital process measures for heart attacks, congestive heart failure, pneumonia and surgical infection prevention
  • The US Department of Health and Human Services’ Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS), which is a national, standardized survey of hospital patients. 
  • The Healthcare Effective Data and Information Set (HEDIS), a survey that is administered by the National Committee for Quality Assurance (NCQA).  This national survey is used by more than 90% of health care plans to measure performance on care and service.
  • The Massachusetts Ambulatory Care Experiences Survey

The final recommendations of this Committee will serve to advise DPH in promulgating regulations under M.G.L. Chapter 111, §25P. 

Open Meeting Law

Pursuant to MGL c.30A, s.18-25, the meetings of the SQAC are subject to Open Meeting Law (OML). The Massachusetts Attorney General’s Regulation 940 CMR 29.10 allows remote participation in a meeting subject to specific restrictions defined in the regulation. The SQAC has voted to permit remote participation in instances in which circumstances meet the compass of unreasonable difficulty and in which a quorum of the public body is physically present, in alignment with OML guidelines and as adjudicated on a case-by-case basis by the Co-Chairs. No committee member may utilize the remote participation function of OML for more than two meetings per year.

Bylaws Overview

The name of the committee shall be the Statewide Quality Advisory Committee (SQAC). As defined under Chapter 288, §54 of the Acts of 2010 the purpose of the SQAC is to serve in an advisory role to the Department of Public Health (“Department”) and the Division of Health Care Finance and Policy (“Division”) in developing a standard quality measure set to enhance uniformity of reporting across the Commonwealth. The product of the SQAC should accordingly be recommendations to the Department to inform promulgation of regulations for measure reporting. Although the primary function of the SQAC will be its advisory role to the Department and the Division, the Committee may elect to express recommendations to the wider stakeholder community regarding adoption of the proposed SQMS, with the understanding that the Department is able to promulgate regulations only within its regulatory purview.

The SQAC does not have a defined end-date, and instead is intended to longitudinally reassess and expand upon the Standard Quality Measure Set. Members of the SQAC are defined by statute. In the event of an open seat, the Co-Chairs will propose nominees to the Governor of the Commonwealth of Massachusetts, who retains the prerogative to fill vacancies. The statute specifies that members serve for two year terms. Members shall have one vote, and only members may vote. Designees are permitted for deliberation only. Members may resign at anytime by notifying the Co-Chairs and the Secretary of the Executive Office of Health and Human Services in writing.

Ex officio members of the committee may elect to have one individual designated to attend in their absence over the course of an annual session.  Designees have the authority to participate in all committee business and to vote on all matters.  Committee members are required to provide written notification to the SQAC Co-Chairs identifying their designee. In accordance with the enabling statute, gubernatorially-appointed committee members may not delegate their voting authority to a designee.  In the event a gubernatorially-appointed member is unable to attend a meeting, they may send a non-voting representative to the SQAC meeting on their behalf.

Any member of the SQAC shall fully disclose any relationship with an individual or with members of other organizations, which represents or has the potential to represent a conflict of interest or result in personal financial gain. The Co-Chairs shall preside over all meetings of the SQAC. In accordance with Massachusetts law, all meetings are subject to OML. Recommendations for revisions to the bylaws shall be considered at the prerogative of the Co-Chairs, and subject to approval by the Committee. The Co-Chairs shall submit them as approved into public record with or without changes.

Committee Scope, Process and Structure

The SQAC will focus on identifying and endorsing measures for inclusion in the Standard Quality Measure Set and on recommending future priorities for quality measurement. With regard to measure identification, the SQAC will issue annual recommendations to the Department for the Standard Quality Measure Set. At a minimum, all endorsed measures will be reassessed every three years to ensure conformity with the priorities of the SQAC and reporting needs in the Commonwealth.

Nominating Non-Mandatory Measures for Evaluation

Each member of the Committee will have the ability to nominate measures for evaluation during SQAC meetings through parliamentary process (nomination, second, deliberation, vote). A majority vote endorsing or rejecting a given measure will be sufficient for consensus. At appropriate times, public attendees will have the opportunity to propose measures for nomination. A member of the SQAC must subsequently nominate such measures to allow for formal consideration by the committee. The SQAC Co-Chairs shall identify the appropriate time frame for measure nomination at the commencement of each annual session.

Approach to Evaluation of Measures

In assessing measures for inclusion in the recommended Standard Quality Measure Set, they will be evaluated against the criteria of priority, validity, and practicality. In keeping with the advisory role of the SQAC, the Co-Chairs will define priorities primarily through the expressed needs of the Department and the Division, but also with input from SQAC members and the public. Validity and practicality shall be semi-quantitatively scored based on alignment with the principles for quality measurement identified by the Health Care Quality and Cost Council (HCQCC). [1]

  • Priority: measures should adhere to at least one of the Committee priority areas. Measures should utilize current public reporting requirements unless there is a demonstration that an enhanced approach is in the public interest.

  • Validity: measures should be sound, just, and well-founded in accordance with HCQCC principles 1, 3, 5 & 6.
    • Wherever possible, measures should be drawn from nationally accepted standard measure sets
    • There must be empirical evidence that the measure provides stable and reliable information, and that the data sources and sample sizes are sufficient for accurate reporting at the level chosen
    • There must be empirical evidence that the measured entity (clinician, site, group, institution) is associated with a significant amount of the variance in the measure. The measures offered for providers should, in totality, be representative of a significant proportion of their practices, OR
      • The measure is important for patients or communities, even though a clear consensus on accountability for performance has not been determined.
    • Providers should be informed about the development and validation of the measures and given the opportunity to view their own performance, ideally for one measurement cycle, before the data are used for public reporting. Where feasible, providers should be permitted to verify data and offer corrections

  • Practicality: measures that are pragmatic, able to be applied without extensive additional work, and meet the practical considerations of this project/program in accordance with HCQCC principles 2 & 4.
    • Ease of data collection
    • The measure must reflect something broadly accepted as meaningful to providers or patients
    • There must be sufficient variability or insufficient performance on the measure to merit attention

As defined by the statute, the four mandated measure sets are a priority and therefore only the tests of validity and practicality should be applied. All measures except those in the mandated four sets must pass a “priority” test to be considered against other principles/criteria. A measure is considered practical based upon current data availability or whether a mechanism to collect the data is in place. A measure’s validity will be considered based upon its alignment with the principles of the Health Care Quality and Cost Council.

All measures that meet the “priority” test are eligible for inclusion in the Standard Quality Measure Set. The performance of a measure or measure set against the tests of validity and practicality will determine the strength of the Committee’s recommendation for their inclusion in the Standard Quality Measure Set.

  • Strong recommendation
    • If measure passes both the Practicality and Validity test, it is given a strong recommendation;

  • Moderate recommendation
    • If measure passes the Validity test, but not Practicality, the measure is considered valid, but further infrastructure development is needed for a strong recommendation;
    • If measure passes the Practicality test, but not Validity, the measure is considered not sufficiently valid, and further work on the methodology is needed for a strong recommendation;

  • Weak recommendation
    • If measure passes neither the Practicality nor Validity tests, the measure is given a weak recommendation.

  • No recommendation
    • If a measure not specified by the enabling statute passes the Priority test, but not the Practicality or Validity tests, the Committee will make no statement with regards to recommendation. Such measures are eligible to be proposed again in future years

Process

Work group staff and consultants will assign preliminary quantitative ratings to each measure or measure set for each aspect.  SQAC members will have an opportunity to ask for clarifications regarding the preliminary ratings and discuss potential adjustments to the ratings before voting to approve or disapprove. For further consideration, a measure must meet a minimum threshold of validity and practicality.  All measures meeting this threshold will be categorized according to the strength of recommendation, determined by their scores on Validity and Practicality.

Annual Reporting Process

The deliverables to be released by the SQAC as part of its annual reporting process are described below.

  • Annual Standard Quality Measure Set: the list of measures recommended for inclusion in the Standard Quality Measure Set, categorized by the strength of recommendation derived from alignment with the evaluation criteria.

  • Measure Evaluation Reports: brief reports outlining how given measures align with the evaluation criteria, and any relevant discussion points. These reports will be released intermittently, following the Committee’s decision whether or not to recommend a given measure or measure set.

  • Annual Priorities Report: the document describing the Committee’s recommendation for the future direction for the Commonwealth’s quality measurement priorities as informed by the Co-Chairs, Committee, and the public at SQAC meetings.

[1] The HCQCC principles are available for review at http://hcqcc.hcf.state.ma.us/Content/AboutTheRatings.aspx.

Download SQAC Bylaws (PDF) pdf format of bylaws-final.pdf | Word doc format of bylaws-final.doc

2012 Meeting Schedule and Materials

DATE / LOCATION

MEETING TOPIC

Meeting #1
Wednesday, January 25, 2012

Meeting Materials

  • Scope of Advisory Committee’s task under Section 54 of Chapter 288 of the Acts of 2010
  • Department of Public Health Regulatory Process
  • Review committee bylaws
  • Review committee work materials

 

Quality Measurement Webinar
Thursday, February 16, 2012

Webinar Materials
 

 Presenters:

  • Barbra Rabson, Massachusetts Health Quality Partners (MHQP)
  • Dr. John Freedman, Expert Consultant to the SQAC

 

Meeting #2
Tuesday, February 21, 2012

Meeting Materials

  • Review Mandated Measures
  • Nominate Other Measures for Review
  • Preliminary "Straw Poll" on Measure Recommendations
 

Meeting #3
Friday, March 30, 2012

Meeting Materials

  • Approval of minutes of February 21, 2012
  • Agency presentations of framework for using  SQAC recommendations
  • Review of mandated measure recommendations, discussion, and vote
  • Update on public nominations
 

Meeting #4
Thursday, April 12, 2012

Meeting Materials

  • Approval of minutes of March 30, 2012 
  • Presentation from the Division of Insurance (DOI)
  • Presentation and discussion of potential measures of Post-Acute Care
  • Follow up on Nominated Measures Process
 
 

Meeting #5
Friday, May 18, 2012

Meeting Materials

  • Approve Minutes from Meeting 3 and Meeting 4
  • Discussion of Care Coordination and Care Transitions Measures
  • Behavioral Health Expert Presentation
  • Discussion of Behavioral Health Measurements
 

Meeting #6
Thursday, June 14, 2012

Meeting Materials

  • Approval of Meeting 5 minutes
  • Presentation by Dr. Paul Jarris, Association of State and Territorial Health Officials (ASTHO) on Community and Population Health Measures
  • Discuss proposed framework for Standard Quality Measure Set
  • Update on nominations and measure review
  

Meeting #7
Tuesday, July 24, 2012

Meeting Materials

  • Approve minutes
  • Discuss rankings of proposed measures (determine if there are any changes to the strong/moderate/weak stratification)
  • Build SQMS from framework
 

Meeting #8
Friday, August 10, 2012

Meeting Materials

  • Approve minutes from Meeting 7
  • Follow-up on SQMS measure and framework discussion
  • Next steps
 

Meeting #9
Friday, November 9, 2012

Meeting Materials

  • Approve minutes from Meeting 8
  • Staff briefing on suitability alignment work
  • Review/approve SQAC final report

 

 

Statewide Quality Advisory Meeting #1
- Wednesday, January 25, 2012

 

 February 16th Webinar - Quality Management

 

Statewide Quality Advisory Meeting #2
- Tuesday, February 21, 2012

 

Statewide Quality Advisory Meeting #3
- Friday, March 30, 2012

  

Statewide Quality Advisory Meeting #4
- Thursday, April 12, 2012

 

Statewide Quality Advisory Meeting #5
- Friday, May 18, 2012

 

Statewide Quality Advisory Meeting #6
- Thursday, June 14th 2012

 

Statewide Quality Advisory Meeting #7
- Tuesday July 24th 2012

 

Statewide Quality Advisory Meeting #8
- Friday, August 10, 2012

 Statewide Quality Advisory Meeting #9
-
Friday, November 9, 2012

Year One Report

SQAC Quality Measures Catalog