Class 3 Flashcards
Significance of quality (regarding payments)
By 2016, CMS is targeting 85% of Medicare FFS payments are linked to quality
By 2018, CMS is targeting 90% of Medicare FFS payments are linked to quality
Quality
The degree to which health services for individuals and populations increase the likelihood of desired health outcomesand are consistent with current professional knowledge
Performance management
The use of performance management information to effect positive change in organizational culture, systems and processes
Performance management components
- Setting goals (help set agreed-upon performance goals)
- Allocating resources (allocate and prioritize resources)
- Evaluating programs (Informing mangers to either confirm or change current policy or program direction to meet those goals)
- Sharing results of performance in pursing those goals
Key agencies for quality management
CMS NCQA (HEDIS measures) AHRQ (ARC measures) National Quality Forum 3M Groupers used in DSRIP
Quality measures based on 6 domains
- Safe
- Effective
- Patient-centered
- Timely
- Efficient
- Equitable
Safe
Avoiding harm to patients from the care that is intended to help them
Effective
Providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit (avoiding underuse and misuse, respectively)
Patient-centered
Providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions
Timely
Reducing waits and sometimes harmful delays for both those who receive and those who give care
Efficient
Avoiding waste, including waste of equipment, supplies, ideas, and energy
Equitable
Providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status
Types of quality measures
- Structural
- Process
- Outcomes
- Patient experience
Structural
Health care provider’s capacity, systems, and processes to provide high-quality care. Ex:
•Whether the health care organization uses electronic medical records or medication order entry systems
•The ratio of providers to patients
Process
What a provider does to maintain or improve health. These processes can contribute to health outcomes. Ex:
•% of people receiving preventive services (such as mammograms or immunizations).
•% of people with diabetes who had their blood sugar tested and controlled