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Healthcare Delivery- JD > Lec 12 - Linking Payment To Quality > Flashcards

Lec 12 - Linking Payment To Quality Flashcards

(57 cards)

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1
Q

Medicare payment cuts for the _______ PTs bill

A

Codes

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2
Q

What are our expectations of quality in the health care system? (Duke)

A

Providers
Payers
Patients
Employers

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3
Q

What are the examples of issues in health care quality?

A

Cost
Quality
Access

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4
Q

What do we expect from other providers in the healthcare system?

A

Timeliness, evidence-based

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5
Q

Relationship of Cost and Outcome: Value in health care is measured by the ________ achieved, not the _______ of services delivered.

A

Outcomes

Volume

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6
Q

Relationship of Cost and Outcome: Shifting focus from volume to ______ is a central challenge

A

Value

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7
Q

Relationship of Cost and Outcome: Cost reduction without regard to the outcomes achieved is dangerous and ____________

A

Self defeating

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8
Q

Alternatives to Cost Reduction: The current payment environment includes what two things?

A

Payment cuts

Move away from fee-for service methodologies

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9
Q

Alternatives to Cost Reduction: Providers need strategies moving away form ___________ models, responding to new payment models

A

COST REDUCTION

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10
Q

Alternatives to Cost Reduction: Providers with better outcomes will grow _________

A

Market share

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11
Q

Alternatives to Cost Reduction: Improved efficiency of providing excellent care will provide __________ in contracting

A

Strength

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12
Q

Alternatives to Cost Reduction: Providers demonstrating increasing value will be most __________

A

Competitive

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13
Q

What is the equation for the relationship of value, quality, and cost?

A

Value = quality/cost

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14
Q

___________ includes clinical outcomes and the patient’s experience

A

Quality

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15
Q

_________ include monetary costs and harm to both patients and the system

A

Costs

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16
Q

Spending more money does not necessarily mean _________ health care

A

Better

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17
Q

Proportion of recommended ________, _______, and _______ care provided 54.9%

A

Preventive
Acute
Chronic

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18
Q

Order of highest quality to lowest quality varied by medical condition

A

Cataracts
Orthopedic conditions
Hip fracture
Alcohol dependence

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19
Q

Dimensions where US Health Care System functions “at far lower level than it should” (STEEEP) stands for what?

A 
Safe
Timely
Effective
Efficient 
Equitable
Patient-centered
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20
Q

SAFE: Avoiding _________ to the patient from the care that is supposed to help them

A

Injuries

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21
Q

TIMELY: Reducing ______ and sometimes harmful delays for both those who receive and those who give care

A

Waits

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22
Q

EFFECTIVE: Providing services based on scientific knowledge to all who could benefit and refraining from providing services to those who are ___________________

A

Not likely to benefit

Avoiding underuse and overuse respectively

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23
Q

EFFICIENT: Avoiding ________, including waste of _________, ________, _____, and ________.

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A 
Waste
Equipment
Supplies
Ideas
Energy
24
Q

EQUITABLE: Providing care that does not vary in quality because of personal characteristics such as _____, _____, _____________, ______________

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A

Gender
Ethnicity
Geographic location
Socioeconomic status

25
PATIENT CENTERED: Providing care that is respectful of and responsive to individual patient preferences, needs and values, and ensuring that patient ________ guide all clinical decisions
VALUES
26
Why quality problems? (3) | __________ of system
Fragmentation
27
Why Quality Problems? Lack of _____ ___________ among health care professionals
Care coordination
28
Why quality problems? Payment is quality _______
Neutral
29
Evolution of Quality Improvement Efforts: Recognition that ________ is not directly linked to dollars spend
Quality
30
Evolution of Quality Improvement Efforts: Variability?
TRUE
31
Evolution of Quality Improvement Efforts: Emphasis on _____________
Public reporting
32
Evolution of Quality Improvement Efforts: Relationship to ___________
Disparities
33
Evolution of Quality Improvement Efforts: Evolution of measurement __________
Science
34
Evolution of Quality Improvement Efforts: Health ________________
Information technology
35
Evolution of Quality Improvement Efforts: Comparative effectiveness ___________
Research
36
What is the Berwick Triple Aim? (And what 3 things did it address?)
High functioning health system 1. Improve the individual experience of care 2. Improve the health of populations 3. Reduce the per capita cost of care
37
Barriers to the Triple Aim: ________-driver demand New technologies including many with limited impacts on ___________ Physician-centric care Little or no _________ competition to spur domestic change, as it does in manufacturing Too little appreciation of ____________ among clinicians and organizations
Supply Outcomes Foreign System
38
The barriers to the triple aim becomes the quadruple aim which improves what?
The work life of providers
39
What is tier 1 of outcomes that matter to patients?
Health status achieved or retained | Example: Hip replacement
40
What are some examples of tier 1?
Survival - mortality rate | Degree of health or recovery - function level, pain level achieved. Extent of return to work, physical activities
41
What is tier 2 of the outcomes that matter to patients?
Process of recovery
42
What are examples of tier 2?
Time to recovery - time to begin treatment, time to return to work/physical activity Disutility of care or treatment process (diagnostic errors, ineffective care, complaications, adverse effects) - delay, anxiety, pain during treatment, LOS, infection PE. DVT, MI, delirium, need to re-operation
43
What is tier 3 of outcomes that matter to patients?
Sustainability of Health
44
What are examples of tier 3?
Sustainability of health or recovery, nature of recurrences - return to prior level of function, independent living, need for revision/replacement Long term consequences of treatment — loss of mobility due to inadequate rehab, regional pain syndromes
45
Quality and PPACA: The ACA seeks to _______ access to _______, affordable health care for all Americans
Increase | High quality
46
T/F? Quality and PPACA: To that end, the law in section 3011, required the secretary of the dept of health and human services to establish a national strategy for quality improvement in health care that sets priorities to guide this effort and includes a strategic plan for how to achieve it.
True
47
What is the national quality strategy?
A nationwide effort to provide direction for improving the quality of health and healthcare in the US
48
The NQS is guided by what 3 aims?
Better care Healthy people and communities Affordable care
49
What does MACRA stand for?
Medicare access and CHIP Reauthorization act of 2015
50
What does MACRA do?
Permanently repeals the flawed sustainable growth rate formula for determining Medicare payments for clinicians’ services and establishes a new framework for rewarding clinicians for value over volume.
51
MACRA streamlines existing quality-reporting programs such as the _____________ into a single new systems, the ________________
Physician Quality Reporting System The Merit based incentive payment system
52
MIPS: HHS - Transition from FFS payment toward _________
Outcome based payment
53
MIPS: Beginning in 2017 for physicians and NPPs, with payment ___________ in 2019.
Adjustment
54
MIPS: PTs will be eligible for voluntary reporting, with __________ __________ expected within a few years
Mandatory reporting
55
What are some other examples of quality initiatives
National quality forum Patient centered outcomes research institute Institute for Healthcare Improvement (and Open School)
56
Primary goal for ACA was what?
ACCESS
57
In the quality of health care delivered to adults study in 2003, what was the overall thing that they found?
1/2 of those who responded didnt get the care that was recommended for the condition they had

Healthcare Delivery- JD (12 decks)

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