A History of and a Vision for CMS Quality Measurement Programs

Goodrich, Kate; Garcia, Edward; Conway, Patrick H.

doi:10.1016/s1553-7250(12)38062-8

Cited by 15 publications

(13 citation statements)

References 4 publications

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“…1 Performance measures currently published on CMS’s Hospital Compare website include those focused on processes of care (e.g., percentage of patientshospitalized for acute myocardial infarction treated with beta blockers); care outcomes, such as condition-specific mortality and readmissionrates; patients’ experience and satisfaction with care; and measuresof hospitalizationcosts and case volumes. 2 Since 2003, CMS has steadily expanded both the number of conditions and measures included in public reporting efforts, and many of these now serve as the basis for the value-based purchasing program legislated in the Affordable Care Act.…”

mentioning

confidence: 99%

Attitudes of Hospital Leaders Toward Publicly Reported Measures of Health Care Quality

et al. 2014

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confidence: 99%

Attitudes of Hospital Leaders Toward Publicly Reported Measures of Health Care Quality

et al. 2014

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“…For example, it is important to know when a given metric is no longer contributing to quality, which was suggested by VanLare and Conway (2) and Goodrich et al (1). That is, when all dialysis facilities perform at such a high level of quality that the year-to-year variances are more reflective of the influx of a single new patient or some random event other than quality, then the ability to show significant addressable variances in quality is lost.…”

Section: Checklist Item 2: Performance Gapmentioning

confidence: 99%

“…The development and use of these metrics are shifting the care delivery paradigm from volume to value, emphasizing the three aims of better population outcomes, better individual patient experience of care, and constraint of health care costs. High-level guiding principles for identifying and creating population-based metrics have been described by senior Medicare leaders in the published literature (1,2). One entity assuming a prominent role for the translation of CMS principles into endorsement of actual facility-level metrics is the National Quality Forum (NQF), a nonprofit, nonpartisan, public service organization committed to the transformation of health care to be safe, equitable, and of the highest value.…”

Section: Introductionmentioning

confidence: 99%

Guiding Principles and Checklist for Population-Based Quality Metrics

Krishnan

Brunelli

Maddux³

et al. 2014

Clinical Journal of the American Society of Nephrology

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The Centers for Medicare and Medicaid Services oversees the ESRD Quality Incentive Program to ensure that the highest quality of health care is provided by outpatient dialysis facilities that treat patients with ESRD. To that end, Centers for Medicare and Medicaid Services uses clinical performance measures to evaluate quality of care under a pay-for-performance or value-based purchasing model. Now more than ever, the ESRD therapeutic area serves as the vanguard of health care delivery. By translating medical evidence into clinical performance measures, the ESRD Prospective Payment System became the first disease-specific sector using the payfor-performance model. A major challenge for the creation and implementation of clinical performance measures is the adjustments that are necessary to transition from taking care of individual patients to managing the care of patient populations. The National Quality Forum and others have developed effective and appropriate population-based clinical performance measures quality metrics that can be aggregated at the physician, hospital, dialysis facility, nursing home, or surgery center level. Clinical performance measures considered for endorsement by the National Quality Forum are evaluated using five key criteria: evidence, performance gap, and priority (impact); reliability; validity; feasibility; and usability and use. We have developed a checklist of special considerations for clinical performance measure development according to these National Quality Forum criteria. Although the checklist is focused on ESRD, it could also have broad application to chronic disease states, where health care delivery organizations seek to enhance quality, safety, and efficiency of their services. Clinical performance measures are likely to become the norm for tracking performance for health care insurers. Thus, it is critical that the methodologies used to develop such metrics serve the payer and the provider and most importantly, reflect what represents the best care to improve patient outcomes.

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“…1 While this initial attempt at public reporting suffered from methodological flaws and was ended in 1993, 2 it represented the beginning of a huge international experiment. This experiment is ongoing and is still pondering the question: BCan providing publicly available information about health care quality direct patient choice of health care providers and simultaneously drive health care organizations to improve?…”

mentioning

confidence: 99%

From Public to Social Reporting of Hospital Quality

Lagu

Greaves

2015

J GEN INTERN MED

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M ore than a quarter-century has passed since the Centers for Medicare and Medicaid Services (CMS) published their first Breport cards^on hospital mortality data. 1 While this initial attempt at public reporting suffered from methodological flaws and was ended in 1993, 2 it represented the beginning of a huge international experiment. This experiment is ongoing and is still pondering the question: BCan providing publicly available information about health care quality direct patient choice of health care providers and simultaneously drive health care organizations to improve? 1T he subsequent years have revealed that public reporting of quality data does seem to drive attempts on the part of physicians and hospitals to improve care. 3 Yet there is still scant evidence that these initiatives have had an impact on where patients choose to receive care. 4 It has been hypothesized that this is related to a lack of awareness of differences in health care quality, limited literacy and numeracy of patients, and poor design of publicly funded quality reporting websites. 5 CMS's Hospital Compare is an example of a site that includes a plethora of data, including information about processes of care (e.g., percentage of patients hospitalized for acute myocardial infarction treated with beta blockers); risk-adjusted outcomes, such as condition-specific mortality and readmission rates; results of surveys of patient experience of care; and measures of hospitalization costs and case volumes. However, despite the hope and expectation that rational patients would use this information to make informed choices, they rarely do. At the very least, the great experiment of public reporting has, thus far, failed to engage patients.In contrast, social media use is widespread and growing. In 2014, 58 % of US adults used the social networking site Facebook. 6 At the same time, 51 % of US hospitals are now on Twitter, and 99 % are covered by Yelp. 7 Patients are also looking for health care quality data online: in 2012, 65 % of Americans were aware of online ratings of physicians and hospitals, and 23 % reported using ratings to choose a physician. 8 Notably, these numbers appear to reflect patients' use of online reviews found on social media sites and commercial rating sites (e.g., Yelp) rather than patients' use of quality data found on government-funded websites.That so many consumers are getting health care quality information from social media and commercial sources raises the question of whether the information that patients get from these sites is of similar value to the information they could get from sites such as Hospital Compare. In this issue of JGIM, Glover et. al. examine whether hospitals' risk-adjusted readmission rates reported on Hospital Compare were associated with the average number of Bstars^patients gave hospitals as part of their Facebook reviews. 9 Most notably, the authors observed that hospitals with lower readmission rates (and thus a higher Bobjective^measure of quality) were more likely to have a higher st...

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A History of and a Vision for CMS Quality Measurement Programs

Cited by 15 publications

References 4 publications

Attitudes of Hospital Leaders Toward Publicly Reported Measures of Health Care Quality

Attitudes of Hospital Leaders Toward Publicly Reported Measures of Health Care Quality

Guiding Principles and Checklist for Population-Based Quality Metrics

From Public to Social Reporting of Hospital Quality

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