Providing medical care is a complex job, but measuring the quality of that care is perhaps an even more challenging task. Determining how we measure quality – and, indeed, what to measure – is a process laid out in thousands of pages of regulations put forth over many years by the Centers for Medicare & Medicaid Services (CMS).
Fortunately, IMO’s Director of Government and Standards, Ann D. Phillips, MHA, pored over these pages in order to provide a look back at the history of quality measurement in healthcare and insight into upcoming policy changes. In IMO’s latest white paper, she unpacks CMS’ challenges with gathering meaningful data and outlines what must change in order for quality measures to truly inform patient care.
Click below to download our white paper or continue reading for an excerpt.
“The tension between what is easier to measure – the process of care – and what is more difficult to measure – the outcomes of care – is limited by data sources and the difficulty of collecting that information. Early initiatives in quality measurement were reliant on administrative claims data and manual chart review to inform a retrospective assessment of care. But, they offered little insight to the outcomes of that care.
Two important pieces of legislation had a significant role in quality measurement. The 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act encouraged a transition to electronic health records (EHRs) by creating financial incentives for providers. It also reduced Medicare fee schedule payments for providers who did not demonstrate “meaningful use” of EHRs for data exchange and quality measurement. The 2010 Patient Protection and Affordable Care Act (PPACA) built upon HITECH by creating additional provisions for quality reporting. This meant that clinicians and hospitals would now be paid based on quality measure performance, not services rendered.”