The National Quality Forum has endorsed a controversial hospital quality measure that assesses Medicare costs for a whole episode of care, including time spent in post-acute settings, the organization recently announced.

The Centers for Medicare & Medicaid Services already is using the measure for its Hospital Inpatient Quality Reporting Program, but NQF endorsement was slow in coming. The group, compromised of consumer and provider healthcare stakeholders, was divided on the measure in an October vote.

One reason for dissent was that “the majority of cost drivers occur in post-acute care settings,” according to information released by the NQF. Hospitals have limited control over these post-acute costs, so their inclusion in the assessment measure strikes some as unfair.

While the NQF Board of Directors now has formally endorsed the measure, the organization has pledged to address members’ concerns related to the post-acute elements, as well concerns related to patients’ socioeconomic status. Patients’ resources affect the level of government support for their healthcare, and this also is largely out of hospitals’ control. NQF says it plans to convene an expert panel on this issue early in 2014.

Those who wish to appeal the endorsement can do so through Jan. 8, via the Forum’s online Quality Positioning System.