PCPI Performance Measures Development Process

The AMA-convened Physician Consortium for Performance Improvement® (PCPI) began its work around performance measures development in 2001. They first developed measures that fell mainly into the primary care arena. Over time, the process and criteria/parameters have shifted to a focus on specialties and shared resources. As of July 2008, 215 individual performance measures in 34 content areas have been developed by PCPI. The National Quality Forum (NQF) has endorsed many voluntary consensus standards for ambulatory care that were submitted by PCPI, the National Committee for Quality Assurance (NCQA), and CMS. In addition, the AQA Alliance has identified 26 performance measures, developed by either the AMA/PCPI or NCQA, as a “starter set” for ambulatory care.

The current process involves the steps outlined below and generally takes three to four months to get to the point of public comment:

  • Early calls between society and PCPI to identify one to two topics on which to work and develop measures
  • Identify clinical guideline as a base for measures
  • Lead organization/cociety co-chair as clinical expertise in selected measurement area
  • PCPI co-chair with methodology expertise
  • Identify workgroup
  • Work plan and schedule
  • Draft measures developed for public comment
  • 30-day public comment period
  • Testing [optional but is encouraged especially if considering measure for NQF submission]
  • Full PCPI vote

In the past, national testing of measures has been via CMS with funding from CMS and the AHRQ, with testing in more local settings completed by the AMA and other partners. Much of the work completed to date related to testing PCPI’s measures has involved assessing electronic data capture and reporting needs and working with vendors.

The lead organization process has been utilized by several societies and alliances to develop measurement sets for specific conditions/processes. Both the AMA/PCPI and lead organization bring resources to the table. Although monies are not exchanged, there is a negotiable, shared budget where in-kind resources are generally traded. One example is a dedicated staff person from the society to support the process by performing activities such as literature searches. A society may make any non-commercial or commercial use of measures developed as a lead organization. Any such revenue may be retained by the society.

Use of Measures

The measures developed through the PCPI process are intended to be physician/provider level measures for physicians/providers managing the on-going care of patients with the particular condition under consideration. These clinical performance measures are designed for individual quality improvement. Some of the measures may also be appropriate for accountability if appropriate sample sizes and implementation rules are achieved.

As a matter of course, PCPI submits accountability measures to the NQF for endorsement consideration. The lead organization/society generally submits the accountability measures, or a subset thereof, to the AQA Alliance for acceptance as well.