Leadership by Example Coordinating Government Roles in Improving Health Care Quality (2003) / Chapter Skim
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4 Performance Measures
4 Performance Measures
Pages 79-107
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From page 79... ...
to work together to establish standardized performance measures across the government programs, as well as public reporting requirements for clinicians, institutional providers, and health plans in each program. These requirements should be implemented for all six major government health care programs and should be applied fairly and equitably across various financing and delivery options within those programs.
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From page 80... ...
Over time, incorporating outcome measures and measures of patient perceptions will allow for a richer assessment of the contributions of health care to improved patient and population health status. The QulC, an interagency committee with representation from the six major government health care programs, is well positioned to coordinate these activities.
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From page 81... ...
The focus in today's health care environment is increasingly on using performance data to measure quality, to demand accountability, and to cultivate an information-rich health care marketplace (American Medical Association, 2001~. Performance measurement is commonplace in government health care programs; its application, however, is often uncoordinated and duplicative.
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From page 82... ...
Two core intermediate outcome measures in adult diabetes care, for example, are the percentage of patients whose most recent hemoglobin Alc level is greater than 9.5 percent and the percentage of patients whose most recent low-density lipoprotein cholesterol level is less than 130 mg/dL. Outcome analysis may require sophisticated statistical techniques, including risk adjustment, to discern the impact of an intervention independent of confounding factors such as comorbidities, socioeconomic characteristics, and local patterns of care (Agency for Healthcare Research Quality, 2002b; Rubin et al., 2001~.
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From page 83... ...
CAMPS employs primarily outcome measures specifically consumers' perceptions of their health plan and personal providers and is used by some state Medicaid agencies, the Medicare program, DOD TRICARE, and public and private employers. NCQA requires managed care plans to field CAMPS and to develop quality improvement projects that address problems identified through CAMPS findings.
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From page 85... ...
Health Plan Employer Data and Information Set HEDIS was introduced by NCQA in 1991, and is updated annually to help purchasers and consumers compare the quality of commercial, Medicaid, and Medicare managed care plans. Its measures are used in many government health care programs, particularly in managed care settings.
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From page 86... ...
.3 The Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (Public Law 106-554) mandated that the Secretary of DHHS report to Congress on the development of standard assessment instruments across a wide array of health care settings, including home care and nursing home care.4 CMS has recently taken steps to shorten the MDS for prospective payment system assessments, effective fuly 2002 (Centers for Medicare and Medicaid Services, 2002d)
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From page 87... ...
. OVERVIEW OF CURRENT PERFORMANCE MEASUREMENT ACTIVITIES Centers for Medicare and Medicaid Services CMS manages the lion's share of the federal responsibilities for three of the government health care programs addressed in this report Medicare, Medicaid, and SCHIP.
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From page 88... ...
By statute, Medicare's quality improvement resources must be allocated to its FFS and Medicare+Choice (M+C) programs in proportion to beneficiary participation in the two delivery systems (Health Care Financing Administration, 1999~.5 Nevertheless, CMS relies much more heavily on regulatory requirements to promote quality in Medicare managed care and in long-term care facilities and programs than in Medicare FFS (MedPAC, 2002~.6 In addition, although CMS employs performance measures to stimulate quality improvement across a wide range of clinical settings and delivery systems, it uses those measures in distinctly different ways in managed care and FFS (MedPAC, 2002~.
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From page 90... ...
Over time, the review organizations became increasingly responsible for protecting the fiscal integrity of the Medicare program and thus were charged with an array of additional responsibilities, such as lowering admission rates, reducing inpatient lengths of stay, providing prior authorizations for some elective procedures, and, just recently, preventing payment errors. In the 1990s, in response to congressional direction, CMS moved the QIOs towards a more proactive, population- and evidence-based approach to measuring and sometimes disclosing provider and health plan performance.
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From page 91... ...
blocker after arrival at hospital patients Time to initiation of reperfusion therapy Aspirin at discharge Beta blocker at discharge Angiotensin-converting enzyme (ACE) inhibitor at discharge for systolic dysfunction Smoking cessation counseling during hospitalization Breast Cancer Early Doctors' Biennial mammogram Medicare Detection (Virginia offices, claims for all Health Quality Center, outpatient female |
From page 92... ...
Data Sources Pneumonia and Doctors' State influenza vaccination rate Centers for influenza (Oklahoma offices, Disease Foundation for Medical outpatient State pneumococcal vaccination Control and Quality, settings rate Prevention's |
From page 93... ...
The quality improvement efforts are based on the premise that ESRD networks "can do more to improve the quality and cost effectiveness of care by bringing typical care into line with the best practices rather than by inspecting individual cases to identify erred treatment" (Centers for Medicare and Medicaid Services, 2001a, p.l) Routine collection and analysis of clinical performance measures are a principal initiative of the program.
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From page 95... ...
Home Health Care Since 1999, CMS has used OASIS for its oversight of home health agencies participating in the Medicare and Medicaid programs. All Medicarecertified home care agencies must collect, computerize, and electronically transmit OASIS data at regular intervals to a CMS-approved central source for all their adult Medicare or Medicaid patients receiving personal care or health services (42 Code of Federal Regulations Part 484~.
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From page 96... ...
There may be greater uniformity in performance data for Medicaid managed care once CMS implements related rules under the Balanced Budget Act of 1997, which directed CMS to develop specific protocols to guide the states' conduct of external quality review of Medicaid managed care plans. In their current form, the protocols assume that states will continue to have flexibility in developing performance measures because they will be required to conduct their performance reviews only in a manner consistent with but not necessarily identical to the protocols (Centers for Medicare and Medicaid Services, 2001d)
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From page 97... ...
Managed care is the dominant delivery system used by SCHIP programs, and the regulations grant CMS the authority to mandate standardized performance measures for managed care plans serving SCHIP enrollees (but not for FFS providers)
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From page 98... ...
26~. The PHI Guide directly addresses this concern and calls for an "enterprise-wide core set of standardized performance measures" to drive improvements in clinical services (DOD TRICARE Management Activity, 2001, p.
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From page 99... ...
HEDIS measures have been used to assess diabetes care, heart attack treatment, ambulatory follow-up after inpatient mental health stays, and cervical cancer screening (Iones et al., 2000; Mencke et al., 2000~. Indian Health Service IHS has developed a performance evaluation system to meet the performance measurement requirements of ICAHO's ORYX initiative and to comply with the Government Performance and Results Act (Indian Health Service, 2000~.
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From page 100... ...
. The committee agrees and believes this to be true for all government health care performance measurement efforts.
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From page 101... ...
NEED TO STANDARDIZE QUALITY PERFORMANCE MEASURES Government health care programs reflect a growing recognition that measuring quality and using quality performance measures to improve health care is central to the federal government's roles of regulator, purchaser, and provider of health care for almost half the U.S. population.
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From page 102... ...
There should be a designated government entity responsible for coordinating the government's performance measurement activities. QuIC has made a strong start in the right direction by convening representatives from the six major government health care programs and initiating various collaborative projects based on voluntary participation, but it lacks a
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From page 103... ...
The committee strongly recommends the use of standardized measures derived from computerized data and public reporting of comparative quality information. It will be important for CMS to reexamine how best to use the QIOs to enhance quality within this context.
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From page 104... ...
2001d. "Protocols for External Quality Review of Medicaid Managed Care Organizations and Prepaid Health Plans." Online.
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From page 105... ...
DOD TRICARE Management Activity.2001. "Population Health Improvement Plan Guide." Online.
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From page 106... ...
2000. Measuring the Quality of Medicaid Managed Care: An Introduction to State Efforts.
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From page 107... ...
2002. "Diabetes quality improvement project." Online.
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