Leadership by Example Coordinating Government Roles in Improving Health Care Quality (2003) / Chapter Skim
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Executive Summary
Executive Summary
Pages 1-20
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Specifically, regulatory processes should be used to establish clinical data reporting requirements; purchasing strategies should provide rewards to providers who achieve higher levels of quality; health care delivery systems operated by public programs should serve as laboratories for the development of 21 st-century care delivery models; and applied health services research should be expanded to accelerate the development of knowledge and tools in support of quality enhancement. A strong quality infrastructure consisting of three components should be built.
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program (see Table ES-1. OVERVIEW OF CURRENT QUALITY ENHANCEMENT PROCESSES Each of the six programs reviewed for this study has both minimum participatory standards for providers and ongoing performance assessment activities.
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has required certain providers participating in Medicare including Medicare+Choice plans, End Stage Renal Disease Networks, and, most recently, nursing homes to comply with standardized quality reporting requirements. Federal law pertaining to the Medicaid program requires that states establish a plan for reviewing the appropriateness and quality of care, and most states contract with QIOs to carry out these reviews (Verdier and Dodge, 2002~.
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Although the quality enhancement processes of the major government programs are moving in a reasonably consistent and appropriate direction, the current set of activities has not closed the quality gap and is unlikely to do so in the future unless changes are made. This is the case for a number of reasons: 1.
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Absent strong federal leadership in addressing safety and quality concerns, progress will continue to be slow. RECOMMENDATION 1: The federal government should assume a strong leadership position in driving the health care sector to improve the safety and quality of health care services provided to the approximately 100 million beneficiaries of the six major government health care programs.
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Providing consumers with comparative performance data on providers and health plans 4. Government health care programs, in collaboration with the Agency for Healthcare Research and Quality (AHRQj, should pursue a rich agenda of applied research and demonstrations focusing on tools, techniques, and approaches to quality enhancement.
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In the government health care programs that provide care through the private sector Medicare, Medicaid, SCHIP, and to some degree DOD TRICARE the federal government has relied primarily on regulatory approaches to promote quality. Regulatory approaches are best suited to establishing a "floor" that protects beneficiaries from providers lacking basic competencies.
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Regulatory processes should be used to establish clinical data reporting requirements applicable to all six major government health care programs.
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Congress should consider directing the Secretary of Health and Human Services to assume a lead role in producing an annual progress report detailing the collaborative and individual efforts of the various government programs to redesign their quality enhancement processes. To achieve the objective of this recommendation, a stronger quality infrastructure consisting of three major components standardized performance measures, computerized clinical information, and comparative quality reporting in the public domain must be developed.
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In 2003, DHHS will be releasing the first National Healthcare Quality Report, which will include measures relevant to six national quality aims recommended by the IOM in an earlier report safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity (Institute of Medicine, 2001~. The National Healthcare Quality Report will also focus on priority health areas common chronic conditions and health care needs of the population (Institute of Medicine, 2002a)
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The government health care programs that provide services directly (i.e., VHA, the remainder of DOD TRICARE, and IHS) should begin work immediately to ensure that they have the information technology capabilities to produce the necessary data.
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b. Government health care programs that deliver services through the private sector (Medicare, Medicaid, SCHIP, and a portion of DOD TRICARE)
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Fifth, the data will likely be useful to states, communities, and public health groups as a tool for identifying gaps in quality and monitoring the impact of community-wide efforts to close these gaps. RECOMMENDATION 6: Starting in FY 2008, each government health care program should make comparative quality reports and data available in the public domain.
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RECOMMENDATION 8: The six government health care programs should work together to develop a comprehensive health services research agenda that will support the quality enhancement processes of all programs. The QuIC (or some similar interdepartmental structure with representation from each of the government health care programs and AHRQ)
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GETTING FROM HERE TO THERE The committee has formulated a very rigorous implementation strategy that calls for the release of an initial set of comparative performance reports for a limited set of standardized measures in 3 years and a fully operational process in 6 years (see Figure ES-1. Specifically, the QuIC would identify standardized performance measure sets for 5 priority areas in FY 2003 and for 10 more in FY 2004.
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Second, conscious and careful redesign of the quality enhancement processes of each of the major government programs will be necessary. The standardized quality measurement and reporting activities proposed in this report are not intended to represent another layer of government oversight, but rather to replace the patchwork of quality measurement activities and projects currently under way.
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QIOs have limited experience in public reporting, although sizable resources are earmarked for this function in their Seventh Scope of Work. Contractual, cultural, organizational, and programmatic modifications will be required for the QIO program to continue playing a central role in the quality enhancement processes of Medicare and other government health care programs.
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The government health care programs should move expeditiously to address all legitimate questions and concerns about their quality enhancement processes, including the reliability and validity of information, measures, and data. All parties should recognize that problems will be encountered along the way with data, measures, and reports, necessitating continuous improvement and refinement.
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1999. The National Quality Forum: a "me-too" or a breakthrough in quality measurement and reporting?
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