16. Strategies for Health Services Performance Improvement Flashcards
“The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge”
Definition of Quality Health Care
Institute of Medicine (IOM) aims for healthcare improvement in 6 quality care dimensions:
- Safe: avoiding injuries
- Effective: evidence-based
- Patient-centered: respectful
- Timely: reducing wait times
- Efficient: avoiding waste
- Equitable: does not vary in quality
Failure to employ many scientifically sound practices as often as they should be
underuse
Failure to eliminate diagnostic tests and interventions when they are not indicated
overuse
Failure to appropriately execute the proper clinical care process
misuse
is the largest single purchaser of health care in the U.S. and the most significant driving force in quality
Centers for Medicare and Medicaid Services (CMS)
CMS strategic plan for quality management is called
Quality Improvement Roadmap
Pay for care in a way that reinforces a commitment to quality and helps providers and patients improve health
Centers for Medicare and Medicaid Services (CMS)
Originally, a voluntary reporting program that provides financial incentives meeting certain criteria. A pay-for-performance method:
Physician Quality Reporting System (PQRS)
The Physician Quality Reporting System (PQRS) was the quality reporting program under Medicare Part ___
B
Eligible professionals, including ____________ that did not satisfactorily report data on quality measures for the January 1, 2015-December 31, 2015 reporting period, were subject to the 2.0% adjustment in their fee schedule amount in 2017.
{The Physician Quality Reporting System (PQRS)}
physical therapists
MACRA: Medicare Access and CHIP Reauthorization Act of 2015, created a new quality payment program (QPP) for Medicare part B.
Starts in 2017 for most providers; PT’s not until…
2019
is a federal agency focused on improving health care quality, including through research funding for quality improvement interventions
Agency for Healthcare Research and Quality (AHRQ)
Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys. Ask consumers and patients to ______ and _______ their experiences with health care.
report on and evaluate
Some CAHPS surveys are used in_________ Purchasing (Pay for Performance) initiatives.
– Instead of only paying for the number of services provided, CMS also pays for providing high quality services.
Value-Based
