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Healthcare Delivery- JD > Lec 12 - Linking Payment To Quality > Flashcards

Lec 12 - Linking Payment To Quality Flashcards

1
Q

Medicare payment cuts for the _______ PTs bill

A

Codes

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2
Q

What are our expectations of quality in the health care system? (Duke)

A

Providers
Payers
Patients
Employers

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3
Q

What are the examples of issues in health care quality?

A

Cost
Quality
Access

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4
Q

What do we expect from other providers in the healthcare system?

A

Timeliness, evidence-based

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5
Q

Relationship of Cost and Outcome: Value in health care is measured by the ________ achieved, not the _______ of services delivered.

A

Outcomes

Volume

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6
Q

Relationship of Cost and Outcome: Shifting focus from volume to ______ is a central challenge

A

Value

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7
Q

Relationship of Cost and Outcome: Cost reduction without regard to the outcomes achieved is dangerous and ____________

A

Self defeating

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8
Q

Alternatives to Cost Reduction: The current payment environment includes what two things?

A

Payment cuts

Move away from fee-for service methodologies

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9
Q

Alternatives to Cost Reduction: Providers need strategies moving away form ___________ models, responding to new payment models

A

COST REDUCTION

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10
Q

Alternatives to Cost Reduction: Providers with better outcomes will grow _________

A

Market share

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11
Q

Alternatives to Cost Reduction: Improved efficiency of providing excellent care will provide __________ in contracting

A

Strength

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12
Q

Alternatives to Cost Reduction: Providers demonstrating increasing value will be most __________

A

Competitive

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13
Q

What is the equation for the relationship of value, quality, and cost?

A

Value = quality/cost

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14
Q

___________ includes clinical outcomes and the patient’s experience

A

Quality

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15
Q

_________ include monetary costs and harm to both patients and the system

A

Costs

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16
Q

Spending more money does not necessarily mean _________ health care

A

Better

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17
Q

Proportion of recommended ________, _______, and _______ care provided 54.9%

A

Preventive
Acute
Chronic

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18
Q

Order of highest quality to lowest quality varied by medical condition

A

Cataracts
Orthopedic conditions
Hip fracture
Alcohol dependence

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19
Q

Dimensions where US Health Care System functions “at far lower level than it should” (STEEEP) stands for what?

A 
Safe
Timely
Effective
Efficient 
Equitable
Patient-centered
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20
Q

SAFE: Avoiding _________ to the patient from the care that is supposed to help them

A

Injuries

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21
Q

TIMELY: Reducing ______ and sometimes harmful delays for both those who receive and those who give care

A

Waits

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22
Q

EFFECTIVE: Providing services based on scientific knowledge to all who could benefit and refraining from providing services to those who are ___________________

A

Not likely to benefit

Avoiding underuse and overuse respectively

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23
Q

EFFICIENT: Avoiding ________, including waste of _________, ________, _____, and ________.

A 
Waste
Equipment
Supplies
Ideas
Energy
24
Q

EQUITABLE: Providing care that does not vary in quality because of personal characteristics such as _____, _____, _____________, ______________

A

Gender
Ethnicity
Geographic location
Socioeconomic status

25
Q

PATIENT CENTERED: Providing care that is respectful of and responsive to individual patient preferences, needs and values, and ensuring that patient ________ guide all clinical decisions

26
Q

Why quality problems? (3)

__________ of system

A

Fragmentation

27
Q

Why Quality Problems? Lack of _____ ___________ among health care professionals

A

Care coordination

28
Q

Why quality problems? Payment is quality _______

29
Q

Evolution of Quality Improvement Efforts: Recognition that ________ is not directly linked to dollars spend

30
Q

Evolution of Quality Improvement Efforts: Variability?

31
Q

Evolution of Quality Improvement Efforts: Emphasis on _____________

A

Public reporting

32
Q

Evolution of Quality Improvement Efforts: Relationship to ___________

A

Disparities

33
Q

Evolution of Quality Improvement Efforts: Evolution of measurement __________

34
Q

Evolution of Quality Improvement Efforts: Health ________________

A

Information technology

35
Q

Evolution of Quality Improvement Efforts: Comparative effectiveness ___________

36
Q

What is the Berwick Triple Aim? (And what 3 things did it address?)

A

High functioning health system

  1. Improve the individual experience of care
  2. Improve the health of populations
  3. Reduce the per capita cost of care
37
Q

Barriers to the Triple Aim:
________-driver demand
New technologies including many with limited impacts on ___________
Physician-centric care
Little or no _________ competition to spur domestic change, as it does in manufacturing
Too little appreciation of ____________ among clinicians and organizations

A

Supply
Outcomes
Foreign
System

38
Q

The barriers to the triple aim becomes the quadruple aim which improves what?

A

The work life of providers

39
Q

What is tier 1 of outcomes that matter to patients?

A

Health status achieved or retained

Example: Hip replacement

40
Q

What are some examples of tier 1?

A

Survival - mortality rate

Degree of health or recovery - function level, pain level achieved. Extent of return to work, physical activities

41
Q

What is tier 2 of the outcomes that matter to patients?

A

Process of recovery

42
Q

What are examples of tier 2?

A

Time to recovery - time to begin treatment, time to return to work/physical activity

Disutility of care or treatment process (diagnostic errors, ineffective care, complaications, adverse effects) - delay, anxiety, pain during treatment, LOS, infection PE. DVT, MI, delirium, need to re-operation

43
Q

What is tier 3 of outcomes that matter to patients?

A

Sustainability of Health

44
Q

What are examples of tier 3?

A

Sustainability of health or recovery, nature of recurrences - return to prior level of function, independent living, need for revision/replacement

Long term consequences of treatment — loss of mobility due to inadequate rehab, regional pain syndromes

45
Q

Quality and PPACA: The ACA seeks to _______ access to _______, affordable health care for all Americans

A

Increase

High quality

46
Q

T/F? Quality and PPACA: To that end, the law in section 3011, required the secretary of the dept of health and human services to establish a national strategy for quality improvement in health care that sets priorities to guide this effort and includes a strategic plan for how to achieve it.

47
Q

What is the national quality strategy?

A

A nationwide effort to provide direction for improving the quality of health and healthcare in the US

48
Q

The NQS is guided by what 3 aims?

A

Better care
Healthy people and communities
Affordable care

49
Q

What does MACRA stand for?

A

Medicare access and CHIP Reauthorization act of 2015

50
Q

What does MACRA do?

A

Permanently repeals the flawed sustainable growth rate formula for determining Medicare payments for clinicians’ services and establishes a new framework for rewarding clinicians for value over volume.

51
Q

MACRA streamlines existing quality-reporting programs such as the _____________ into a single new systems, the ________________

A

Physician Quality Reporting System

The Merit based incentive payment system

52
Q

MIPS: HHS - Transition from FFS payment toward _________

A

Outcome based payment

53
Q

MIPS: Beginning in 2017 for physicians and NPPs, with payment ___________ in 2019.

A

Adjustment

54
Q

MIPS: PTs will be eligible for voluntary reporting, with __________ __________ expected within a few years

A

Mandatory reporting

55
Q

What are some other examples of quality initiatives

A

National quality forum
Patient centered outcomes research institute
Institute for Healthcare Improvement (and Open School)

56
Q

Primary goal for ACA was what?

57
Q

In the quality of health care delivered to adults study in 2003, what was the overall thing that they found?

A

1/2 of those who responded didnt get the care that was recommended for the condition they had

Healthcare Delivery- JD (12 decks)

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