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a measure that summarizes structure, processes or outcomes
systematically developed statements assisting practitioner and patient decisions prospectivly for specific clinical circumstances.
measurable element of practive performance for which there is evidence or that it can be used to asses quality of care provided.
National committee of quality assurance
- non for profit dedicated to improving health care quality
- provides accreditation to health care organizations
- builds and updates halthcare effectiveness data and information set tool
Characteristics of a quality indicator
- face validity
- sensitivity to change
- predictive ability
- demonstrates evidence
- represents the concept being assessed
acceptable by those measuring or being measured
consistent, reliable, valid data available to construct the QI
reproducible findings whin multiple organizations collect it
Sensitivity to change
can it detect change in the quality of care
can it predict quality of care outcomes
convening expert panel to review and make decisions
Quality indicators are metrics that
capture the rates of processes of care at a health care organization
Quality indicators are distinct from other performance indicators or guidelines because they
infer the level of quality at an organization
Quality indicators are built using...
an extensive process of literature reviews and consensus
Quality indicators are used for research purposes in....
identifying disparities in care
Quality indicators are used by health care organizations for...
reporting and reimbursement purposes
Information from MCOs and Hospitals are submitted to CMS...
CMS audits and posts results on...
Hospital Compare website
CMS computes bonuses base upon....
Challenges in reporting quality scores
- abstracting the info from clinical records
- annual changes in HEDIS quality measures
- CMS auditing process
Objectives of the GAO report
- how hospitals collect and submit quality data
- how CMS works to ensure reliability of the data
Selected findings of the GAO report
- challenges locating data
- scope required for a data element slows collection rate
- incorporating changes in HEDIS measures
- no ongoing process for ensuring completeness of quality of data
Implications reported by the GAO
- increase resources needed for quality indicator processing and reporting
- risks of erroneous data
- opportunities for health IT
Definition of pay-for-performance
a provider reimburement system that rewards providers based upon achiving pre-determined benchmarks of care.
Goals of P4P
create financial incentives in order to improve quality of health care delivery
Outcomes of P4P
- increased transparency
- increased accountability
- decreased costs?
Considerations in designing P4P
- are bonuses sufficient to change provider behavior?
- what are the administrative costs of reporting quality scores?
- Does your practice have sufficient expertiese and infrastructure to collect data to report to CMS
P4P incentive systems
- relative rank
- relative rank with penalties
- target attainment
- target attainment plus improvement
- percentage recomendation
rank order based upon performance
Relative rank with penalties
- rank order based on performance
- reward top 2, punish 5th
hit benchmark (yes/no)
Target attainment plus improvement
- hit benchmark (yes/no)
- historical performance taken into consideration
proportion of patients receiving recommended care
Ideal P4P systems
- reward for high quality
- give all providers incentives
- create a payment gradient that is sufficient to change provider behavior
Pros of relative rank
- advantage to top performers
- high gradient
cons of relative rank
little incentive for low performances to improve
can achieve one area to compensate for deficiencies in another area
- little incentive to improve beyond target
- little incentive for low performers
allows all to improve
may encourage overutilization
Advantages of Pay for performance system
- consumer choice
- aligns incentives
disadvantages of pay for performance systems
- provider buy-in
- linked to outcomes?
- financial burden
- insufficient auditing
- potential inequality or disparities
- misaligned incentives