The U.S. health care system has changed significantly since President Barack Obama signed the Patient Protection and Affordable Care Act (ACA) into law on March 23, 2010.1 At the heart of these changes is an increasing emphasis on reducing health care expenditures by accelerating the implementation of alternative payment models that reward value-based care rather than volume-based services.
In late January, for example, the U.S. Department of Health and Human Services (HHS) announced its goal of tying 30% of traditional, fee-for-service Medicare payments to quality or value through alternative payment models by the end of 2016, and tying 50% of payments to these models by the end of 2018.2
This dramatic shift is predicated on two important questions. First, what is value? The value of health care has been defined as a ratio of quality (including outcomes of care, safety, and service) to the cost per patient over time.3 This means that efforts to promote patient-centered, value-based care solely by reducing costs, with no attention to quality, may have the unintended consequence of decreasing the value of care. Therefore, it is essential to focus on improving quality in addition to lowering costs.
This leads to the second question: Who defines quality? Regarding the field of sleep medicine, the board of directors of the American Academy of Sleep Medicine (AASM) determined that it should be sleep specialists who define quality of care for our own field.
Therefore, in 2013 the AASM appointed a Quality Measures Task Force led by Timothy Morgenthaler, MD who has extensive experience championing quality improvement for Mayo Clinic. Under his leadership, the AASM chartered five workgroups of sleep specialists to develop quality measures for sleep disorders assessment and management. Each workgroup was given the assignment of developing two to 10 process measures and one to three outcome measures for a common sleep disorder, with the understanding that these measures, if implemented, would promote improvements in quality of care and allow for comparisons between care contexts.
Following a comprehensive literature review and grading process, each workgroup developed candidate measures that went through small scale testing at their own practices and were then submitted for review and comment by a variety of stakeholders including sleep specialists, primary care providers, other medical specialists, professional organizations, and patient advocacy groups. This feedback elicited additional revisions, and then the final quality measures were reviewed and approved by the AASM board of directors. The summary paper, “Measurement of Quality to Improve Care in Sleep Medicine,” was published in the March 2015 issue of the Journal of Clinical Sleep Medicine along with five workgroup papers presenting outcome and process measures to aid in evaluating the quality of care of restless legs syndrome, insomnia, narcolepsy, obstructive sleep apnea in adults, and obstructive sleep apnea in children.4 All of these open access papers are available for download here.