Quality Improvement in Medicare

Background

In many health care systems, the quality of care delivered to consumers has significant deficiencies. Preventable medical errors, unsafe care, and other health care quality shortfalls are costly. They can also result in worse health and even loss of life. A body of evidence indicates that there is no relationship between spending and quality. For example, geographic areas in which MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). spending is higher do not always have better care outcomes.

The Centers for MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). & MedicaidA joint federal/state program that provides health care and LTSS. However, to qualify for Medicaid LTSS, people must have extremely low assets and income, or they have to “spend down” most of their assets. Services (CMS) is ultimately responsible for ensuring that all MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). providers and clinicians participating in MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). meet high quality-of-care standards. Providers include nursing homes, home health agencies, hospitals, hospice providers, and end-stage renal disease providers. Clinicians include physicians, nurses, and other health care professionals. CMS employs several quality strategies to meet that responsibility.

These include:

  • establishing and enforcing quality standards, such as publishing information to support accountability;
  • providing technical assistance through Quality Improvement Organizations (QIOs);
  • promoting collaborations and partnerships focused on improving quality;
  • supporting or directly providing consumer assistance and information about quality, such as through public reporting;
  • expanding the use of quality measures that are meaningful to consumers and families in demonstrations and quality improvement projects; and
  • structuring payment and coverage to improve care quality.

CMS executes these strategies largely by managing quality improvement initiatives through partnerships with stakeholders by identifying priority clinical areas, adopting or developing performance measures, and collecting, analyzing, and publishing data and comparative reports. For Traditional MedicareTraditional Medicare, also known as Original or Fee-For-Service Medicare, works on a fee-for-service basis. This means that you can go to any doctor or hospital that accepts Medicare, anywhere in the United States, and Medicare will pay its share of the bill for any Medicare-covered service it… , CMS fulfills its responsibility directly and through contracts with organizations that monitor, survey, inspect, and review the provision of MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). services. Quality contractors include state survey and certification units and independent accrediting bodies. The QIOs collect and analyze data on patterns of care and outcomes to help physicians and other providers improve the quality of beneficiaries’ care.

QUALITY IMPROVEMENT IN MEDICARE: Policy

QUALITY IMPROVEMENT IN MEDICARE: Policy

Quality oversight and improvement

Congress should provide sufficient funding for the Centers for MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). & MedicaidA joint federal/state program that provides health care and LTSS. However, to qualify for Medicaid LTSS, people must have extremely low assets and income, or they have to “spend down” most of their assets. Services (CMS) to meet its responsibilities for quality oversight and improvement.

CMS should develop and maintain adequate data systems to assess quality of care in the Traditional MedicareTraditional Medicare, also known as Original or Fee-For-Service Medicare, works on a fee-for-service basis. This means that you can go to any doctor or hospital that accepts Medicare, anywhere in the United States, and Medicare will pay its share of the bill for any Medicare-covered service it… program.

Additionally, CMS should:

  • continue to develop and implement measures for important clinical areas, cross-cutting issues (such as complications and care coordination), patient experience and engagement, patient-reported outcomes, and episodes of care that span care settings;
  • ensure that quality improvement programs regularly evaluate whether there are improvements in outcomes and related processes—participating providers and practitioners should be required to implement patient-safety programs;
  • hold payment contractors, state survey agencies, independent accrediting bodies, and Quality Improvement Organizations accountable for quality reviews and inspections;
  • address beneficiary complaints and pursue national clinical projects to measure access to and timeliness of care, and the appropriateness of setting, treatment, and discharge;
  • continue to offer information to help beneficiaries and others assess efficiency, continuity, and coordination of care;
  • take action against providers or practitioners when necessary to protect beneficiaries from substandard care; and
  • continue partnerships with other agencies to promote improvements in beneficiary care and well-being.