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ADA takes lead on quality measures

'We need to remain a key participant in ongoing policy debates'

The ADA is taking the lead role in forming a Dental Quality Alliance that will develop programmatic performance measures to assess oral health care quality for Medicaid patients.

Responding to a federal agency's request that the ADA guide the effort, the ADA Board of Trustees, on June 14, approved the formation of a steering committee for a Dental Quality Alliance. The steering committee will establish the agenda for the DQA and manage its work overall.

"If the ADA assumes the leadership role, it will be the driving force in both the steering committee and the DQA," Dr. Conan Davis, chief dental officer at the Centers for Medicare and Medicaid Services told the Council on Dental Benefit Programs at its November 2008 meeting. "The steering committee will develop the internal protocols for the DQA, not CMS."

The widespread movement across the health care system to improve the quality of care for Medicaid patients and to reduce wasteful spending compelled CMS to propose that the group be developed and led by the ADA. The 2008 ADA House of Delegates responded by directing Res. 34H-2008—"the ADA shall explore the development of a Dental Quality Alliance in the oral health care delivery system and after obtaining additional and sufficient information, the Board, in consultation with the appropriate ADA agencies, shall determine if participation should be pursued by the ADA."

After reviewing input from ADA agencies, including the councils on Dental Benefit Programs, Dental Practice and Government Affairs, the Board in December 2008 decided the ADA should go forward with a leadership role in the group's formation.

In responding to CMS' proposal, the ADA considered the impact such a group could have on the profession's responsibility to monitor and regulate itself and concerns that any performance measurement system be applied appropriately to serve the best interests of patients.

"We're going to gather the perspectives of rank and file dentists to be sure they'll be able to utilize any measures developed in their practices," said Dr. Christopher Smiley, CDBP member. "We want to be in the driver's seat to develop programmatic population-based quality measures that are for the advancement of oral health and not simply cost containment measures."

Traditionally, the ADA has not supported the development of quality and performance measures for dental care, except for the ADA Dental Practice Parameters, which were completed by the Association in 1992 and, more recently, evidence-based clinical recommendations. Both the parameters and the evidence-based clinical recommendations are intended for voluntary use by dentists to aid in their clinical decision-making.

With the government pushing harder for health care reform than ever before—a certainty on the legislative agenda, with dentistry's likely inclusion—and Congressional approval of the SCHIP legislation contingent upon having quality measures in place, ADA leaders believe it's essential that the Association take the opportunity to lead the DQA initiative. (SCHIP is the State Children's Health Insurance Program).

"As health care reform moves forward, the profession wants to maintain its longstanding leadership role in quality assessment and improvement," said ADA President John S. Findley. "We need to remain a credible, key participant in ongoing policy debates and decision-making overall. A DQA established by the ADA is another way the profession can transparently demonstrate that role."

Over the past 10 years, many health care organizations that have a stake in evaluating the quality of care have been developing health care quality alliances. They are usually formed by a lead group, such as a professional association, and include other professionally related members who collaborate to develop clinical, evidence-based performance measures and disseminate them. A few examples of such alliances that have been formed to date are the Ambulatory Care Quality Alliance, the American Medical Association's Physician Consortium for Performance Improvement, the Hospital Quality Alliance and the Pharmacy Quality Alliance.

"A DQA established by the ADA gives the Association the greatest opportunity to provide leadership in determining the specific content of performance measures and to guide the application of them," said Dr. Joseph Hagenbruch, CDBP chair. "As the most well-recognized authority on clinical oral health care, the Association is in a position to best lead a collaboration of understanding and distinguish among the factors that most often affect clinical care and its outcomes."

With the understanding that the ultimate goal of the DQA is to ensure patients' experiences and outcomes of care are optimal, not to focus on the actions of individual practitioners, the Board in June approved CDBP's recommendation that a representative from each of the following groups serve on the steering committee:

  • Council on Government Affairs;
  • Council on Dental Practice;
  • Council on Dental Benefit Programs;
  • Board of Trustees;
  • American Academy of Pediatric Dentistry;
  • Academy of General Dentistry;
  • National Association of Dental Plans;
  • American Dental Education Association;
  • Centers for Medicaid and Medicare Services.

The steering committee will meet on December 3-4 at ADA Headquarters in Chicago. The ADA News will feature ongoing stories about the DQA as work proceeds.

Those interested in participating in the DQA as its work develops should e-mail their names, addresses, phone numbers, e-mails and any specific organization affiliations to Dr. David Preble, CDBP director, at prebled@ada.org.