Health Care Quality

Question 1

Reasons why employers should focus on the quality of health care (4)

Answer 1

1. ) There are many errors in delivery of health care services
2. ) Substantial evidence of extensive overuse and underuse of various services
3. ) Can have negative consequences in relationships with employees, providers, and others in the community
4. ) Poor quality erodes value of health care purchases

Question 2

Components of quality care (3)

Answer 2

1. ) Appropriateness - given current state of the art in medicine
2. ) Excellence - in execution of care
3. ) Patient satisfaction

Question 3

Considerations in assessing physician quality (8)

Answer 3

1. ) Asses physician’s training, experience, and prof certifications
2. ) Review history of malpractice claims
3. ) For specialty physicians, consider advanced training received, experience with procedure, complication and mortality rates, and success rates
4. ) NCQA developed some programs to recognize high quality physicians
5. ) For physicians in managed care plans, review performance report cards provided by the MCO
6. ) Review ratings provided by patients, which are published on various website
7. ) Review Physician Quality Reporting Initiative data from CMS
8. ) Schedule an office visit for evaluating the physician’s communication skills

Question 4

Considerations in assessing hospital quality (7)

Answer 4

1. ) Should have appropriate accreditations (from state, CMS, Joint Commission)
2. ) Consider results of the Joint Commission on-site surveys
3. ) American Hospital Association information (on hospital facilities, personnel, and services)
4. ) Consider if a major teaching hospital (these have lower mortality rates for certain conditions)
5. ) Review hospital quality rating provided by The Leapfrog Group and HealthGrades
6. ) Review government data sources on hospital performance
7. ) For specific procedures or conditions of interest, directly ask the hospitals (regarding volume of admissions, complication & mortality rates, and success rates)

Question 5

Considerations in assessing MCO quality (4)

Answer 5

1. ) Accreditations by the NCQA
2. ) Info may be available from state dep of public health or state dep of insurance
3. ) Review MCO’s credentialing criteria, quality assurance plan, and preventive care programs
4. ) Consider performing a site visit

Question 6

Accreditiation by NCQA (4)

Answer 6

1. ) Based on site visit
2. ) Review of MCO’s quality-related processes
3. ) MCO’s HEDIS measures
4. ) Scored as: excellent, commendable, accredited, provisional, and denied

Question 7

Provider approaches for improving quality (supply management) (6)

Answer 7

1. ) Promote continuous quality improvement plans
2. ) Large employers can use quality care data to selectively contract with providers
3. ) Use bundled payments to encourage providers to be more efficient and reduce errors
4. ) Provide feedback on hospital and medical staff performance
5. ) Contract with ACO
6. ) Use performance incentives (P4P programs)

Question 8

Consumer approaches for improving quality (demand management) (7)

Answer 8

1. ) Design cost sharing that encourages avoidance of unnecessary care
2. ) Provide preventive services
3. ) Use shared decision-making programs to get the consumer involved
4. ) Disseminate info about provider quality
5. ) Offer telephonic nurse counseling services
6. ) Offer telephonic DM programs
7. ) Encourage use of reliable internet sources (i.e. US dep of Health and Human Services)

Question 9

Use for quality and efficiency measurements (10)

Answer 9

1. ) Prof standards
2. ) Gov oversight
3. ) Prof accreditation
4. ) Quality improvement
5. ) Network development
6. ) P4P programs
7. ) Public reporting
8. ) Consumer health education
9. ) Financial management
10. ) Purchaser decision making

Question 10

Quality report limitations and measurement challenges (6)

Answer 10

1. ) report includes both insured and not insured populations
2. ) size and complexity is US healthcare system - various stakeholders, decentralized healthcare system, FFS payment system
3. ) Different definitions of quality
4. ) Different approaches to measure quality and efficiency
5. ) Diverse stakeholders
6. ) Fast pace of change of measurement practice

Question 11

Fundamental concepts for measuring healthcare efficiency (5)

Answer 11

1. ) Evaluate and reduce variation
2. ) Group and measure similar illness
3. ) Evaluate resource use
4. ) Reward clinically sound care
5. ) Greater consensus regarding quality measures compared with the efficiency measures