Public Accountability and Evaluation

RECOMMENDATION NO. 4. Congress should establish a Quality Program Advisory Commission (QualPAC) to oversee activities of the MPAQ and to report to Congress on these activities.

RECOMMENDATION NO. 5. Congress should establish within DHHS a National Council on Medicare Quality Assurance to assist in the implementation, operation, and evaluation of the MPAQ.

RECOMMENDATION NO. 6. Congress should direct the Secretary of DHHS to report to Congress, no less frequently than every two years, on the quality of care for Medicare beneficiaries and on the effectiveness of MPAQ in meeting the goals outlined in recommendation no. 2.

In addition to the MPAQ and its MQROs, we have recommended that two other entities be created to form a comprehensive structure to promote, coordinate, and supervise quality review and assurance activities at the national level. Because of the importance of these public accountability and oversight activities, we also suggest that the Secretary of DHHS establish a Technical Advisory Panel to assist in the evaluation efforts. These bodies will have four major purposes, namely to bring a greater degree of public and scientific oversight and input into the quality assurance program, provide a way for both the MPAQ and the MQROs to avail themselves of the most advanced techniques available through the private sector, provide a basis by which the program itself can be more effectively evaluated, and assist the program in management and operations.

Hospital Conditions of Participation

RECOMMENDATION NO. 7. Congress should direct the Secretary of DHHS to initiate a program to make the Medicare Conditions of Participation consistent with and supportive of the overall federal quality assurance effort.

This report emphasizes the use of process-of-care information and especially patient outcomes data in evaluating quality of care. Nevertheless, all conceptual frameworks of quality assurance emphasize the importance of the capacity of an organization to render high quality care—essentially a structural measure. Indirectly, such capacity is measured through mechanisms such as accreditation. For the hospital sector and Medicare, this translates into “deemed status” for those facilities accredited mainly through the Joint Commission for Accreditation of Healthcare Organizations and certification through state survey and certification agencies for those not so accredited.

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