Quality Improvement in Medicare

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. Despite an increase in public reporting of health providers’ performance on quality of care and patient safety, improvements have been slow. Without meaningful improvements, patients will continue to experience preventable hospitalization, worse health, and even loss of life. Evidence indicates that higher spending does not always translate into higher quality. And higher quality care does not necessarily mean costs must be higher. For example, geographic areas where Medicare spending is higher do not always have better care outcomes. 

The Centers for Medicare & Medicaid Services (CMS) is ultimately responsible for ensuring that all Medicare providers and clinicians participating in Medicare 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; and 
• expanding the use of quality measures that are meaningful to consumers and families in demonstrations and quality improvement projects. 

CMS executes these strategies primarily by managing quality improvement initiatives through partnerships with stakeholders, identifying priority clinical areas, adopting or developing performance measures, and collecting, analyzing, and publishing data and comparative reports. For Traditional Medicare, CMS fulfills its responsibility directly and through contracts with organizations that monitor, survey, inspect, and review the provision of Medicare 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. In addition, CMS encourages providers to improve quality care by linking payment to performance measures on quality in value-based programs.