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Comment & Response
February 13, 2018

Costs of Quality Measurement

Author Affiliations
  • 1Evolent Health, Arlington, Virginia
JAMA. 2018;319(6):615. doi:10.1001/jama.2017.20288

To the Editor We agree with Dr Schuster and colleagues that measuring the cost of quality measurement is an important but often overlooked link in the quality strategy.1 We suggest that measure developers should estimate the contextual cost rather than the absolute cost.

One component of contextual cost is the incremental cost triggered by adding 1 measure to an existing measure set or quality measurement infrastructure. As mentioned in the Viewpoint, quality measurement has become routine and widespread; thus it is not common to have an organization discarding what it has and creating a totally new system for 1 new measure. A more useful approach is to estimate cost contextually based on organizations’ different existing infrastructures. For example, adding a measure for a laboratory test will likely trigger different costs for an organization that only has access to claims compared with another organization that has been routinely reporting other laboratory-based measures such as HbA1c for diabetes. On the other hand, adding a chart-based measure, regardless of its complexity, is likely to cost similar levels of resources for both organizations.