The measure steward is responsible for submitting updated information to the NQF. Failure to do so results in a lapse of NQF endorsement. Measure maintenance also provides an opportunity for harmonization with other, similar measures. An ad hoc review of an endorsed measure may be requested and is granted on a case-by-case basis. At the end of this evaluation process, a measure may be kept, modified, or harmonized with other measures, or retired if it is no longer clinically relevant. For example, PQRS measure 10, which measured the documentation rate of the presence

or absence of stroke, hemorrhage, or mass on brain CT and MRI reports, was retired by the NQF at the end find more of 2012. Stated reasons for retirement included a lack of evidence supporting whether the actual documentation of the presence or absence of these results affected outcomes or would change practice, as well as the fact that tissue plasminogen activator was often administered long before the report was finalized. For these and other reasons, the NQF determined that the measure did not meet the criteria for importance to measure and report, and the measure

is no longer listed in its endorsed measures set [30]. Although data on the AZD6244 nmr effectiveness of pay-for-performance initiatives have thus far been varied 31, 32, 33 and 34, Congress has mandated the institution of a variety of programs that will increasingly affect reimbursement for individual practitioners, groups, and institutions. Limitations of currently instituted performance measures include wide aminophylline variation in background evidence, limitations in the sources of data collection, and a lack of evidence that process measures affect outcomes [35]. Moreover, relatively few measures assess important clinical issues such as the rate of diagnostic errors and the appropriateness of diagnostic studies and therapies 36 and 37. A recent report by the Robert Wood Johnson Foundation made 7 policy recommendations for improving the application of performance measurement, including that performance measures focus on outcomes instead of processes, that they measure patient experience of care, and that quality measures be used in conjunction

with other quality initiatives [37]. Nonetheless, performance measures are important for radiologists because they allow the identification of quality gaps and the assessment of opportunities for improvement and because reporting is being increasingly tied to reimbursement. Performance measurement against defined benchmarks, such as national, regional, or registry-based benchmarks including the ACR National Radiology Data Registry, provides information that allows radiology practices to assess their performance gaps and plan for quality improvement. Radiologists should also be involved in developing performance measures so that new measures are clinically relevant and best reflect what is important for patients, referring providers, and a radiology practice.