Question

• Discuss the organizations involved in public reporting of quality performance data for healthcare organizations.
• Discuss the organizations that provide quality performance measures.
• Discuss the organizations that provide a forum or provide services for healthcare organizations interested in quality performance improvement.

Answer 1

Public reporting used to address the quality and cost in healthcare system by providing consumers, health care providers with information about the performance of these providers and insurance plans.

Quality performance measures are tools that help measure or quantify healthcare processes, outcomes, patient perceptions, and organizational structure and/or systems that are associated with the ability to provide high-quality health care and/or that relate to one or more quality goals for health care.

Organizations that provide quality performance measures

• The Joint Commission(TJC) :Hospitals and health systems maintain TJC accreditation in their clinical care processes, ability and performance on specific quality measures and standards of care. TJC has established standardised core performance measures set for hospital operations and contributes to the national strategy for improving healthcare quality transparency.

• Centre for Medicare and Medicaid Services (CMS):It provides a standardised process for ensuring that CMS will have a rational, conspicuous system to measure the quality of care delivered to recipients.This system was developed in coordination with the other organizations and collaborates with private and nonprofit organizations.

• National Committee for Quality Assurance (NCQA):It is one of the main certification and accreditation organizations for patient-centric medical home initiatives, health plan accreditations, disease and case management, and other healthcare provider certification and recognition programs.It provides and governs the development of the Healthcare Effectiveness Data and Information Set (HEDIS) ambulatory care measures.
• National Quality Forum (NQF): Focus on building consensus on national healthcare goals and priorities for quality measurement and performance improvement. As new quality measures are developed and tested, the NQF plays a vital role in validating measures prior to official use and implementation.
• American Medical Association (AMA) :The AMA, a national association for physicians, assembled the Physician Consortium for Performance Improvement( PCPI) which is continually working to develop measures on patient-centric care.
• Agency for Healthcare Research and Quality (AHRQ): It provides a clearinghouse for quality measures, coordination of evidence-based best practics, and annual reportings of national clinical quality measures. It also manages the Consumer Assessment of Healthcare Providers and Systems (CAHPS) patient satisfaction surveys.
• Utilization Review Accreditation Commission (URAC):It is a healthcare quality accreditation organization for health plans, provider organizations, and physician practices with various accreditation and certification programs.It  serve an important purpose for insurance commissioners, state and federal legislators, employers, and consumers because they are a sign of a high quality and represent the organization’s ability to meet agreeable performance metrics levels.

organisations for quality improvement:

It is one of the largest federal programs dedicated to improving health quality for Medicare beneficiaries.

There are two types of quality improvement organisations

Beneficiary and Family Centered Care (BFCC)

BFCC help Medicare beneficiaries exercise their right to high-quality health care. They manage all beneficiary complaints and quality of care reviews to ensure consistency in the review process while taking into consideration local factors important to beneficiaries and their families. They also handle cases in which beneficiaries want to appeal a health care provider’s decision to discharge them from the hospital or discontinue other types of services.

Quality Innovation Network (QIN)

They bring Medicare beneficiaries, providers, and communities together in data-driven initiatives that increase patient safety, make communities healthier, better coordinate post-hospital care, and improve clinical quality.