Healthcare News & Insights

Hospital quality measures: What’s CMS planning now?

137218845How are hospitals doing when it comes to meeting certain federal quality measures? Pretty well, according to a new analysis released by the Centers for Medicare & Medicaid Services (CMS). But there’s still work to be done.

The report lays out how quality measures are positively impacting healthcare delivery, as well as the agency’s future plans for improvement. Not only is the report a good overview of how hospitals have performed, it’s also a glimpse into how CMS will be changing its quality programs in the not-too-distant future.

Progress toward goals

CMS reviewed its quality control program to make sure it’s making progress in six key areas:

  1. Making care safer
  2. Ensuring that each person and family are engaged
  3. Promoting effective communication and coordination of care
  4. Promoting the most effective prevention and treatment practices
  5. Working with communities to promote wide use of best practices to enable healthy living, and
  6. Making quality care affordable.

So far, the agency says, hospitals and healthcare providers in general are doing well at working toward these goals, particularly when it comes to improving the process of treating inpatient heart failure and improvements for surgical processes. More and more hospitals are meeting and exceeding performance goals, saving thousands of lives.

But CMS would like a better idea of just how well its quality benchmarks are being met, and whether they’re as effective as they should be for preventing patient harms.

Overall impact on patients

To that end, the agency says it’ll evaluate existing quality measures for conditions that have a significant impact on patients’ health, such as effectiveness at treating cardiovascular disease. And it’ll use these high-impact conditions to develop additional measures aimed at ensuring that care remains patient-centered across the continuum of care.

CMS is also considering aligning its quality measures better with those of other state and federal programs, such as state Medicaid measures and measures from the Veterans Health Administration. This will further increase continuity across all existing quality initiatives.

Continuity and consistency are important because CMS’ quality initiatives affect a wide variety of patients, not just Medicare recipients. In fact, when measuring patient outcomes, over 40% of the measures CMS uses include patients who are receiving Medicaid, and 30% receive insurance coverage from other private payors.

And CMS is planning to make sure those patients are counted when measuring national progress toward meeting quality benchmarks. To do this, the agency plans to use “data sources, such as electronic health records and all-payer databases” to evaluate outcomes for a larger group of patients – and it’ll use that information to create new, more comprehensive quality measures.

So even if your hospital doesn’t have a large number of Medicare beneficiaries in its patient mix, it’s still important to monitor how well your quality of care matches up with federal benchmarks.

The feds aren’t just looking at the outcomes for Medicare patients. The care for all patients with the conditions described by each quality measure will be evaluated. And your hospital will face scrutiny if it doesn’t make the grade.

Data integrity

Regarding its quality improvement programs, CMS also wants to make sure that the progress hospitals are making isn’t due to “teaching for the test,” either by focusing solely on meeting one measure at the cost of others – or manipulating reported data to make it seem like their progress is better than it actually is.

As a way to make sure this doesn’t happen, CMS may start using a third-party data validation process where either an agency-affiliated contractor or a third-party authorized vendor will review data once it’s reported. The goal of this additional scrutiny would be to ensure accuracy and to spot any negative consequences of focusing on certain quality measures over others – such as a drop in performance.

Avoiding disparities

CMS also wants to make sure that quality improvements are occurring in similar numbers across patients of all socioeconomic backgrounds and ethnicities. Overall, disparities in care are decreasing along racial and ethnic lines when it comes to meeting quality benchmarks, but there’s still a great deal of room for improvement.

So CMS will be standardizing the collection of race and ethnicity data across all its reporting programs. This will make it easier for the agency to spot disparities and come up with programs and initiatives to reduce them. And the data will be publicly reported along with all other quality measures so CMS can closely monitor hospitals’ progress.

Process measures

Right now, many of the measures in CMS’ quality programs focus on processes – that is, improving hospitals’ performance when it comes to standardizing treatment for certain conditions. These standards are typically based on established best practices that have improved patient outcomes.

CMS is thinking of adding a new type of measure into the mix: patient-reported outcomes. That way, hospitals and other healthcare providers won’t just be judged on how they report a patient’s outcome. They’ll also be evaluated based on how patients and their families interpret the end result of their treatment. The differences may be subtle, but they could offer a perspective about care delivery that hospital-reported data may not capture.

Using this info, along with other data collected, CMS eventually wants to directly link process-oriented measures to patient outcomes. This may affect hospitals’ performance in meeting the standards for these quality measures down the line.

And over time, the agency plans to place more focus on the process-oriented measures where there’s more variation in provider performance, rather than those where all hospitals and providers perform consistently well. So hospitals may face even more scrutiny if their performance falls short of established norms.

What hospitals can do now

Given how important it’s become for hospitals to perform well when it comes to federal quality measures, it’s wise to start preparing for these changes as soon as possible by looking to improve any weaknesses in your hospital’s care delivery process.

Since facilities will be judged more harshly for falling short in the future, fixing any problems now is the smartest move.

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