Question

What does the CMS quality initiative include, and how can the initiative and its relationship be described to the National Quality Strategy?

How can the data publicly available on the compare site for the quality initiative benefit a healthcare organization?

How can the measurement data can be used to improve performance in the setting in a hospital setting?

Answer 1

Ans) CMS implements quality initiatives to assure quality healthcare for Medicare and Medicaid beneficiaries through accountability and public disclosure. lWe use quality measures in a variety of quality initiatives that include incentive programs, thus giving a higher reimbursement for reporting quality measures.

- Hospital Compare:

Hospital Compare is a consumer-oriented website that provides information on how well hospitals provide recommended care to their patients. This information can help consumers make informed decisions about where to go for health care. Hospital Compare allows consumers to select multiple hospitals and directly compare performance measure information related to heart attack, heart failure, pneumonia, surgery and other conditions. These results are organized by:

General information
Survey of patients' experiences
Timely & effective care
Complications
Readmissions & deaths
Use of medical imaging
Payment & value of care
Access the Hospital Compare Web site at www.medicare.gov/hospitalcompare

Hospital Compare was created through the efforts of Medicare and the Hospital Quality Alliance (HQA). The HQA: Improving Care Through Information was created in December 2002. The HQA was a public-private collaboration established in December 2002 to promote reporting on hospital quality of care. The HQA consisted of organizations that represented consumers, hospitals, providers, employers, accrediting organizations, and federal agencies. The HQA effort was intended to make it easier for consumers to make informed health care decisions and to support efforts to improve quality in U.S. hospitals. Since it's inception, many new measures and topics have been displayed in the site.  

In 2005, the first set of 10 "core" process of care measures were displayed on such topics as heart attack, heart failure, pneumonia and surgical care.  

In March 2008, data from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, also known as the CAHPS Hospital Survey, was added to Hospital Compare. HCAHPS provides a standardized instrument and data collection methodology for measuring patient's perspectives on hospital care. Also in 2008, data on hospital 30-day mortality for heart attack and heart failure was displayed. Later in 2008, mortality rates for pneumonia was added.  

In 2009, CMS added data on hospital outpatient facilities, which included outpatient imaging efficiency data as well as emergency department and surgical process of care measures.  

2010 saw the addition of 30-day readmission measures for heart attack, heart failure and pneumonia patients.

In 2011, CMS began posting data on Hospital Associated Infections (HAIs) received from the Centers for Disease Control and Preventions (CDC) National Healthcare Safety Network (NHNS). The measure sets have been expanded to include ICU's and other hospital wards.

In 2012, we added the CMS readmission reduction program and measures that were voluntarily submitted by hospitals participating the American College of Surgeons National Surgical Quality Improvement Program. The three measures are:

Lower Extremity Bypass surgical outcomes
Outcomes in Surgeries for Patients 65 Years of Age or Older
Colon Surgery Outcomes
Hospital Compare saw the addition of the Hospital Value Based Purchasing program data in 2013.  

CMS continues to evolve the website, with the addition of the Overall Hospital Quality Star Rating in July 2016 and the re-introduction of measure data from Veterans Health Administration Hospitals.

-  Performance measurement systems should be defined in a published national or regional plan for
quality and performance management that clarifies the values and participation of stakeholders.
2. Governments need to take stock of existing approaches and programmes, to encourage
harmonization of standards, measurements, incentives and public information and to foster
collaboration between the public and private sectors.
3. The underlying values, reference standards and objectives of hospital performance measurement
systems should be made explicit and agreed with stakeholders.
4. The system should not rely on single sources of data but should combine a range of informants.
5. All approaches to performance measurement suffer from behavioural and technical problems, and a
general lack of robust evidence to define their active ingredients.
6. The design of performance measurement systems should aim to manage and improve hospital
performance, rather than to generate unreliable rankings and comparisons.
7. Relevant principles based on international experience include:
a. Performance failures are more often a result of failures in systems and processes rather
than of individual competence or knowledge.
b. Performance assessment requires reliable methods of measurement against validated
standards.
c. The reliability of indicators is determined primarily by the accuracy, completeness and
timeliness of patient-based data collected at institutional level.
d. Valid comparisons of performance between institutions demand rigorous standardization
of assessment criteria and methods, especially if they are to be used between countries.