Measuring quality of care is the essential foundation for improving care, and improving the care provided to Medicare and Medicaid beneficiaries is the central goal of HCFA's Health Care Quality Improvement Program (HCQIP) (Gagel, 1995).
Full Answer
Can We monitor the quality of medical care provided to Medicare beneficiaries?
Context: Despite condition-specific and managed care-specific reports, no systematic program has been developed for monitoring the quality of medical care provided to Medicare beneficiaries.
What are quality measures in healthcare?
Quality measures are tools that help us measure or quantify healthcare processes, outcomes, patient perceptions, and organizational structure and/or systems that are associated with the ability to provide high-quality health care and/or that relate to one or more quality goals for health care.
What are the quality initiatives of the Centers for Medicare?
CMS implements quality initiatives to assure quality health care for Medicare Beneficiaries through accountability and public disclosure. CMS uses quality measures in its various quality initiatives that include quality improvement, pay for reporting, and public reporting.
Can We model a Medicare beneficiary complaint process for Quality Improvement Organizations?
The Center for Medicare Advocacy recently convened a conference with key stakeholders on Quality Improvement Organizations and the beneficiary complaint process: Beyond QIO: Modeling A Medicare Beneficiary Complaint Process For Quality Of Care.
Why is it important to measure quality of care?
Measuring the quality of healthcare can: Guard against abuses and misuse of healthcare services. Ensure patient safety. Reveal areas where interventions might improve care.
Why is it important for patients to be involved in quality improvement in health care?
Overall improving the quality and performance in the healthcare environment can help providers with reliable, cost-effective and sustained healthcare processes and enable them to achieve their goal of improving care delivery and enhancing patient outcomes.
What is the purpose of quality assurance in healthcare?
It involves assessing or evaluating quality; identifying problems or issues with care delivery and designing quality improvement activities to overcome them; and follow-up monitoring to make sure the activities did what they were supposed to.
Why is it important to know about CMS in healthcare?
The CMS oversees programs including Medicare, Medicaid, the Children's Health Insurance Program (CHIP), and the state and federal health insurance marketplaces. CMS collects and analyzes data, produces research reports, and works to eliminate instances of fraud and abuse within the healthcare system.
What are quality measures and why are they important?
Quality measures are tools that help us measure or quantify healthcare processes, outcomes, patient perceptions, and organizational structure and/or systems that are associated with the ability to provide high-quality health care and/or that relate to one or more quality goals for health care.
What is the main purpose of quality improvement?
What Is the Main Purpose of Quality Improvement? Quality improvement aims to create efficiencies and address the needs of customers. In healthcare, the main purpose of quality improvement is to improve outcomes.
What are the benefits of quality assurance?
Quality assurance gives you deep insight into your customers' needs, wants and satisfaction, as well as your agents' performance. It allows you to tailor your support strategies, perfectionism your services, adjust focus on what needs to be improved, but also boost your employees' motivation for better performance.
Why quality assurance is important in nursing?
The main purpose of Quality assurance is a way of preventing mistakes and to assure the public that the services provided by nurses are committed to continuing competence and quality improvement in order to meet the expectations of receiver, management and regulatory body.
What does CMS mean in Medicare?
Centers for Medicare & Medicaid ServicesHome - Centers for Medicare & Medicaid Services. CMS.
What are the purposes of Medicare regulations?
Medicare Regulations means that certain government-sponsored insurance program under Title XVIII, P.L. 89-97, of the Social Security Act, which, among other things, provides for a health insurance system for eligible elderly and disabled individuals, as set forth at Section 1395, et seq.
What is CMS Center for Medicare?
The federal agency that runs the Medicare, Medicaid, and Children's Health Insurance Programs, and the federally facilitated Marketplace.
Who is responsible for investigating and resolving Medicare quality of care complaints?
As part of its overall mission to improve the quality of health care for Medicare beneficiaries, the Social Security Act places the responsibility for investigating and resolving “quality of care” complaints from Medicare beneficiaries with the QIOs.
Why is quality of care important?
However, its importance as an advocacy tool for obtaining and maintaining services is often less obvious . Such issues are integral to understanding who receives care, the promptness and appropriateness of care, and to understanding systemically the reasons why quality and access problems occur. A focus on quality allows beneficiaries and their advocates to participate in the development of appropriate monitoring and enforcement of quality standards. The Center for Medicare Advocacy focuses on quality not only to raise general consumer awareness of this important topic, but to highlight the use of this growing body of knowledge by advocates to secure and expand services. Racial and ethnic minority populations and the larger disabled community should pay particular attention to these issues because these groups tend to be less supported by the health care community.
What can a beneficiary do if he or she believes that the medical care that the doctor prescribed was inadequate or
What can a beneficiary do if he or she believes that the medical care that the doctor prescribed was inadequate or incorrect in some way? In Medicare, beneficiaries may request a “quality of care review” and question the level or kind of services provided by their practitioner or provider.
What are the barriers to quality of care?
These include: Entry into the Health care system; the accessibility of care. Structural Barriers; the ease of navigating through the system to receive the best care.
What is slow pace in healthcare?
The slow pace with which new technology, information and guidelines are adopted by the health care industry. Current and historical lack of government incentives, standards, or direction. Inconsistent care by physicians and other health care professionals.
What are the factors that prevent many Americans from receiving the highest standards of care?
They include: The slow pace with which new technology, information and guidelines are adopted by the health care industry.
Why do people not receive health care?
There are many people who do not receive quality care because of their race, ethnicity, gender, socio-economic status, age or health status. As evidenced in the current national debates over universal health care, not everyone has insurance, or access to health care.
What is indicator information?
Indicator information is best presented in rather different ways for quality improvement and for public release. In particular, data presented in terms of compliance with a standard may be suitable for "report
What is a credible process indicator?
Credible process indicators address specific elements of care whose linkage to good outcomes has been demonstrated, such as
What is biomedical research?
Much biomedical research has been devoted to showing that certain treatments and processes of care lead to better outcomes, and this research can be translated into explicit indicators of quality . There
Who developed the chronic disease indicators?
The chronic disease indicators address processes of care. They were developed under a contract between HCFA, the Delmarva Foundation for Medical Care Inc., and the Harvard School of Public Health. The contractor reviewed all cur
When was the HHA indicator developed?
The HHA indicators were developed by Shaughnessy and colleagues (Shaughnessy, 1994 ). Reliability and validity studies are complete; data collection for a pilot of operational feasibility, including risk adjustment methods, will begin in summer 1995, with larger scale collection in 1996.