Quality Assurance Flashcards
What are quality definitions based on?
Product characteristics, production performance, monetary (financial) value, utility (economic) value, idealistic philosophy
What is the international standard definition of quality?
Degree to which a set of inherent characteristics fulfills needs and expectations
When did the continuous improvement process begin?
Roots in early Hx of automotive industry with Ford’s assembly line 1908
How did countries respond to industrial expansion after WWII?
America- auto focus on scale of production; Europe- superior product; Japan- just right
What is the core principle of the continuous quality improvement process?
Feedback- Self reflection of process
What is the purpose of continuous improvement process?
Efficiency- Identification, reduction, and elimination of sub optical processes
What is the emphasis of continuous improvement process?
Evolution- incremental continuous steps rather than giant leaps
What are the three general components of the continuous improvement process?
Feedback, efficiency, and evolution
T/F The mission is never accomplished in continuous improvement
True
Why are incentives given in continuous improvement?
To drive the process forward
When are new goals set in continuous improvement?
As soon as stated goals are reached
What are three ways continuous improvement relates to healthcare?
1) assess and improve health care and health outcomes 2) reduce disparities in health and health care for minority populations 3) build data infrastructure
What is HEDIS?
Healthcare effectiveness data and information set, scores healthcare plan
Who developed HEDIS?
The national committee for quality assurance
Who must submit HEDIS data?
HMOs must submit for Medicare enrollees, required by CMS
What is MIPS?
Merit-based incentive payment system, replaced PQRS physician quality reporting system
What are the four MIPS categories?
Quality, cost, improvement activities, advancing care information
What is MACRA?
Medicare access and CHIP (child’s health) reauthorization act, MIPS is under MACRA
How can you look up a MIPS score?
National provider identification database
When did MIPS scores begin?
January 1 2017
What is MIPS for?
Annually measures eligible providers in 4 performance categories to derive a MIPS score 0 to 100
How does the MIPS score impact a provider’s Medicare reimbursement?
Each payment year impacted by -9% to +27% by 2022 (SCO doesn’t use it)
What is in the MIPS equation?
Quality, resource use, clinical practice improvement activities, advancing care information
Over the past 3 years how has quality performance been used to calculate MIPS composite performance score?
Started at 60% then 50 and 30 (cost and resource use increased from 0 to 10 to 30)
Who gets +27% from MIPS?
The top 25% (of those in the running for +9%)
Is MIPS used in optometry?
Yes, there is a process with goals, metrics, and reports
What are the measures in MIPS and optometry?
There are 6 measures for which to submit collected data, one measure should be an outcome measure (high priority measure if no outcome measure)
How can quality measure bonus points be earned?
Submission of 2 or more outcome or high priority quality measures AND/OR submission using end to end electronic reporting
What four ways does quality assurance healthcare impact me?
Health insurance plans, health policy, healthcare manufacturing, and practitioners
How do health insurance plans affect me?
HEDIS- health plan proving to government that they are helping their patients
How does health policy affect me?
NCQA- national committee on quality assurance
How does healthcare manufacturing affect me?
Pharmaceuticals and medical devices
How do practitioners affect me?
Reimbursement rates (PQRS), insurance panel status, medical staff appointments
What are the three essential factors and goals of quality assurance?
Peer reviewed (de-identified), systematic (defined intervals, randomized selection), compiled feedback (process outcome/benchmark, new outcomes identified)
