GAO: HHS' EHR quality measures taking too long, costing too much

The Government Accountability Office (GAO) suggested that the Department of Health and Human Services (HHS) should address the performance of the National Quality Forum (NQF), a Washington, D.C.-based nonprofit organization contracted by the HHS to retool existing and develop new quality measures for use in the EHR incentive programs.

The January GAO report revealed the NQF did not meet deadlines outlined in its contract, it exceeded cost estimates and 44 of its completed retooled measures contained errors.

According to the report, the NQF completed 26 of and made progress on 34 of the 63 projects outlined in its contract with the HHS between Jan. 14, 2010, and Aug. 31, 2011, but did not meet deadlines for 18 of its completed projects and did not expect to meet deadlines for 14 of the projects currently in progress. Additionally, the NQF exceeded cost estimates by approximately $560,000 in the second year of its four-year contract.

“While the retooling project was expected to be completed by September 2010, its completion was delayed three months,” the report read, pointing to a single project as an example. “NQF and HHS officials identified various reasons that contributed to this delay, including an expansion of the project’s scope and complexity.”

To remedy the situation, the GAO report recommended that the HHS use all monitoring tools available and required by its contract with the NQF to monitor the NQF’s performance. The report noted that while the HHS monitored the NQF through monthly progress reports and approved changes to deadlines and costs, it did not perform an annual performance evaluation and did not begin collecting financial graphs with the NQF’s monthly progress reports until August 2011.

“By not taking advantage of these tools, HHS runs the risk of not having detailed and timely information that could help identify instances in which NQF might be at risk of not meeting time frames or exceeding estimated costs,” the report read. “Identifying such instances could provide an opportunity for HHS to make any appropriate changes to NQF’s scope of work, including setting priorities to ensure that HHS receives the best quality measures it needs in a timely manner.”

The report also recommended that the HHS:

• Test measures developed by or retooled by the NQF in a timely fashion to ensure that they are error-free for use in the EHR incentive programs, and
• Create a plan for developing quality measures that meet legal requirements and the needs of various HHS programs, and share that plan with the NQF.

“Given that NQF is the entity in the U.S. with lead responsibility for endorsing healthcare quality measures, NQF’s endorsement activities under the contract are of key importance to help meet HHS’s quality measurement needs,” concluded the report.

The HHS did not agree or disagree with the GAO’s recommendations, according to the report, and the NQF concurred with most of the report’s content.