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Optometric Practice II > Quality Assurance > Flashcards

Quality Assurance Flashcards

1
Q

What are quality definitions based on?

A

Product characteristics, production performance, monetary (financial) value, utility (economic) value, idealistic philosophy

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2
Q

What is the international standard definition of quality?

A

Degree to which a set of inherent characteristics fulfills needs and expectations

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3
Q

When did the continuous improvement process begin?

A

Roots in early Hx of automotive industry with Ford’s assembly line 1908

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4
Q

How did countries respond to industrial expansion after WWII?

A

America- auto focus on scale of production; Europe- superior product; Japan- just right

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5
Q

What is the core principle of the continuous quality improvement process?

A

Feedback- Self reflection of process

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6
Q

What is the purpose of continuous improvement process?

A

Efficiency- Identification, reduction, and elimination of sub optical processes

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7
Q

What is the emphasis of continuous improvement process?

A

Evolution- incremental continuous steps rather than giant leaps

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8
Q

What are the three general components of the continuous improvement process?

A

Feedback, efficiency, and evolution

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9
Q

T/F The mission is never accomplished in continuous improvement

A

True

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10
Q

Why are incentives given in continuous improvement?

A

To drive the process forward

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11
Q

When are new goals set in continuous improvement?

A

As soon as stated goals are reached

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12
Q

What are three ways continuous improvement relates to healthcare?

A

1) assess and improve health care and health outcomes 2) reduce disparities in health and health care for minority populations 3) build data infrastructure

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13
Q

What is HEDIS?

A

Healthcare effectiveness data and information set, scores healthcare plan

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14
Q

Who developed HEDIS?

A

The national committee for quality assurance

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15
Q

Who must submit HEDIS data?

A

HMOs must submit for Medicare enrollees, required by CMS

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16
Q

What is MIPS?

A

Merit-based incentive payment system, replaced PQRS physician quality reporting system

17
Q

What are the four MIPS categories?

A

Quality, cost, improvement activities, advancing care information

18
Q

What is MACRA?

A

Medicare access and CHIP (child’s health) reauthorization act, MIPS is under MACRA

19
Q

How can you look up a MIPS score?

A

National provider identification database

20
Q

When did MIPS scores begin?

A

January 1 2017

21
Q

What is MIPS for?

A

Annually measures eligible providers in 4 performance categories to derive a MIPS score 0 to 100

22
Q

How does the MIPS score impact a provider’s Medicare reimbursement?

A

Each payment year impacted by -9% to +27% by 2022 (SCO doesn’t use it)

23
Q

What is in the MIPS equation?

A

Quality, resource use, clinical practice improvement activities, advancing care information

24
Q

Over the past 3 years how has quality performance been used to calculate MIPS composite performance score?

A

Started at 60% then 50 and 30 (cost and resource use increased from 0 to 10 to 30)

25
Q

Who gets +27% from MIPS?

A

The top 25% (of those in the running for +9%)

26
Q

Is MIPS used in optometry?

A

Yes, there is a process with goals, metrics, and reports

27
Q

What are the measures in MIPS and optometry?

A

There are 6 measures for which to submit collected data, one measure should be an outcome measure (high priority measure if no outcome measure)

28
Q

How can quality measure bonus points be earned?

A

Submission of 2 or more outcome or high priority quality measures AND/OR submission using end to end electronic reporting

29
Q

What four ways does quality assurance healthcare impact me?

A

Health insurance plans, health policy, healthcare manufacturing, and practitioners

30
Q

How do health insurance plans affect me?

A

HEDIS- health plan proving to government that they are helping their patients

31
Q

How does health policy affect me?

A

NCQA- national committee on quality assurance

32
Q

How does healthcare manufacturing affect me?

A

Pharmaceuticals and medical devices

33
Q

How do practitioners affect me?

A

Reimbursement rates (PQRS), insurance panel status, medical staff appointments

34
Q

What are the three essential factors and goals of quality assurance?

A

Peer reviewed (de-identified), systematic (defined intervals, randomized selection), compiled feedback (process outcome/benchmark, new outcomes identified)

Optometric Practice II (9 decks)

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