Leadership by Example Coordinating Government Roles in Improving Health Care Quality (2003) / Chapter Skim
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3 Coordinating the Roles of the Federal Government to Enhance Quality of Care
3 Coordinating the Roles of the Federal Government to Enhance Quality of Care
Pages 56-78
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From page 56... ...
b. All six major government health care programs should vigorously pursue purchasing strategies that encourage the adoption of best practices through the release of public domain comparative quality data and the provision of financial and other rewards to providers that achieve high levels of quality.
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From page 57... ...
Regulatory requirements can have adverse impacts as well, by creating unnecessary reporting burdens, conveying conflicting objectives, and omitting essential elements of quality. | Best existing | funs \ ~ | State-of-the-art | | care l FIGURE 3-1 Distribution of care by level of quality, a conceptual scheme.
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From page 58... ...
Purchasing strategies can raise the quality of care provided by the majority of providers thus shifting the curve to the right. Such strategies include public disclosure of comparative quality data on providers and health plans, and financial and other rewards for high levels of quality.
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From page 59... ...
As discussed in Chapter 5, VHA and DOD have also led the way in building clinical information systems to support care delivery, quality improvement, patient safety, surveillance and monitoring, and many other applications. As a major sponsor of applied health services research, the federal government provides support for the development of the knowledge and creation of the tools needed to carry out more effectively the regulator, purchaser, and health care delivery roles.
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From page 60... ...
Specifically, the remainder of this chapter examines some of the ways in which the government health care programs could employ regulatory, purchasing, and care delivery strategies in their quality enhancement processes. Current efforts to standardize and coordinate those processes across the six programs are reviewed, and an overall approach to quality enhancement that maximally leverages the various government roles is outlined.
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From page 61... ...
It is through these two government programs, which contract with the majority of private providers, that the federal government has the greatest impact on the nation's health care delivery system. Other government health care programs tend to apply many of Medicare's regulatory requirements.
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62 H cry .
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From page 64... ...
SOURCES: Department of Defense, 1995, 2001; Indian Health Service, 2001b; Pittman, 2002; and Veterans Administration, 2001. the supply of primary care providers)
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The National Committee for Quality Assurance (NCQA) was recently granted deeming authority for certain requirements pertaining to M+C plans and has similar authority for health plans in TRICARE and in some states for Medicaid (NCQA, 2002~.
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From page 66... ...
States, however, have considerable latitude in how they choose to define, implement, and enforce quality review; the level and degree of external review vary widely among the states. With the growth of Medicare and Medicaid managed care options in the 1990s and in response to concerns about burden and conflicting quality requirements, CMS developed the Quality Improvement System for Managed Care (QISMC)
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From page 67... ...
In addition to Medicare and Medicaid, other government health care programs rely to varying degrees on external review to safeguard quality. The DOD TRICARE program contracts with the Keystone Peer Review Organization to review the appropriateness of care for about 1,500 medical, surgical, and mental health cases per month; to certify mental health facilities; and to handle patient and provider appeals.
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From page 68... ...
In the Medicare program, the federal government has taken some steps consistent with its purchaser role by facilitating disclosure of comparative quality data in the public domain. In 1998, the National Medicare Education Program an initiative to educate beneficiaries about Medicare health care options was launched.
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From page 69... ...
Although beyond the immediate scope of the present study, it should be noted that the federal government has pursued a purchaser approach in carrying out its responsibilities under the Federal Employees Health Benefits Program. For health plans participating in this program, federal employees can access CAMPS and HEDIS data and summary results from NCQA accreditation surveys (Office of Personnel Management, 2002~.
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From page 70... ...
VistA serves as the foundation for an extensive program of quality measurement and improvement and clinical decision support, including ongoing benchmarking across a wide range of preventive, acute, and chronic care quality measures; automated entry of medication orders; a notification system that alerts clinicians about clinically significant events identified through the use of integrated laboratory, radiology, pharmacy, progress notes, and other data; a clinical reminder system to promote evidence-based practice; and use of bar codes for medication administration and verification of blood type prior to transfusion. The DOD TRICARE program conducts numerous quality measurement and improvement projects, including ones that use the HEDIS measurement set and beneficiary surveys such as CAMPS.
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From page 71... ...
The National Center for Patient Safety, used for evaluating "close calls" and adverse events. Institutional providers, IHS providers, clinicians, and networks hospitals, health that serve active duty centers, and clinics military personnel and other DOD TRICARE beneficiaries Numerous special quality studies, including ones that use HEDIS measures and .
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From page 72... ...
The agency is mandated by statute to provide coordination of quality improvement programs and activities among the various government health care programs. The primary vehicle for this purpose is the Quality Interagency Coordinating Committee (QuIC)
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From page 73... ...
There is little doubt that the federal government could play its various roles more effectively to both promote improvements in quality within each of the government health care programs and drive improvement in the health care sector overall. The federal government should exercise appropriate influence through each of its roles to the maximum extent possible to promote quality improvements.
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From page 74... ...
There are many variations in quality enhancement requirements across the government health care programs, some rooted in differences among the needs of the populations served, but most stemming from the fact that the programs have developed their quality enhancement processes independently. In the absence of compelling reasons for differences in quality enhancement requirements, the federal government should strive to provide the same minimal level of quality protection to all populations served.
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From page 75... ...
The increased emphasis on clinical quality measurement in all of the federal health care programs is a positive development, highlighting the potential for the federal government to encourage greater coordination and standardization of performance measurement efforts across government programs and, indeed, throughout the health care sector overall. In the absence of strong federal leadership and a clear strategy for coordinating the efforts of various government health care programs, the likely outcome will be a duplicative and burdensome patchwork of quality measurement data of limited utility to end users (as discussed further in Chapter 4~.
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From page 76... ...
The challenge for federal quality enhancement processes is to harness their potential to drive and facilitate quality improvement throughout the health care delivery system. Without coordination, standardization, dissemination of information, and incentives, fulfillment of that potential will be impossible to attain.
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From page 77... ...
.2002. "Report to Congress: Applying Quality Improvement Standards in Medicare." Online.
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From page 78... ...
IHS Conditions of Participation, Roles of the Federal and State Governments, and Quality Improvement. Personal communication to Jill Eden.
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