WHAT ARE QUALITY MEASURES?

Quality measures are tools used to assess the ability of a healthcare provider to deliver quality care that is effective, safe, efficient, patient-centered, fair, and timely. Most quality measures are based on evidence-based medicine, which can be narrowly defined as utilization of the best current data and research to inform clinical decision-making. There are several organizations that focus on quality measures, and we'll explore some here. As usual, the Centers for Medicare and Medicaid Services (CMS) is a useful resource on quality as well.

CMS utilizes what is known as the Measure Management System to develop, implement, and maintain healthcare quality measures. CMS uses these measures to assess the quality of care that is delivered to its beneficiaries and as the basis for its various quality initiatives and programs including the Hospital Quality Initiative and the Physician Quality Reporting System (PQRS). The Measure Management System has been developed in collaboration with prominent healthcare quality organizations including the National Quality Forum (NQF), the Agency for Healthcare Research and Quality (AHRQ), the Joint Commission, the National Committee for Quality Assurance (NCQA), and the American Medical Association Physician Consortium for Performance Improvement (AMA PCPI). The quality data collected has been used in conjunction with other CMS data to build the Quality Care Finder that can be found on Medicare.gov. Links to each of the quality organizations mentioned above can be found in the quality resources area, and we'd suggest exploring them in more detail if you are interested in learning more about development of quality measures.

So we've explained what quality measures are and what they are used for in general, but what do they actually measure? In general, quality measures are used to track outcomes and whether or not providers are offering necessary and evidence-based services to patients given the circumstances. In other words, if quality-based medicine says that a certain type of care should be provided given a certain patient condition, quality measures are used to ensure that patients are receiving that recommended care. For example, physicians might report on the percentage of women 40-69 years of age who have had a mammogram to screen for breast cancer in the last 24 months or the percentage of adults 50-75 years of age who have had appropriate screening for colorectal cancer (e.g. colonoscopy). Hospitals might report on how many heart attack patients received aspirin within 24 hours of hospital arrival or how many patients are readmitted to the hospital within 30 days of being discharged with a certain condition. There are over a thousand CMS quality measures that span various providers and specialties, and it is clearly beyond our scope to explain them all. However, hopefully these few examples have given you an idea of actual quality measures and how they are used. The entire list of CMS quality measures, known as the CMS Measures Inventory, can be found on the CMS website.

The National Committee for Quality Assurance (NCQA) probably warrants its own brief discussion here because the NCQA focuses primarily on tracking health insurance plan quality. NCQA utilizes what are known as Healthcare Effectiveness Data and Information Set (HEDIS) measures to assess the quality of care that health plans provide to their members. Insurance carriers track and report HEDIS measures, and CMS requires them to report Medicare HEDIS data in order to offer Medicare Advantage plans. NCQA offers an excellent tool to compare health plans on customer satisfaction and quality called the Health Plan Report Card. Consumers can enter their state and the plan type they're looking for and search available plans. Individual insurers can then be chosen to compare on a report card. Some health insurance carriers have begun offering premium designations to network providers who meet certain quality and cost data benchmarks that carriers set and track. These designations can be helpful for patients attempting to find a quality provider, so we suggest contacting your insurance plan if you are interested in learning more.

Essential QSA Knowledge

Quality measures are used to track outcomes and whether or not providers are offering necessary and evidence-based services to patients given the circumstances. In other words, if quality-based medicine says that a certain type of care should be provided given a certain patient condition, quality measures are used to ensure that patients are receiving that recommended care. CMS is a good resource to utilize for quality measures as they work with the major healthcare quality organizations to develop their measures and have developed provider comparison tools available on Medicare.gov. The NCQA tracks health insurance plan quality and is a great resource to compare the quality of health insurance providers in your area.

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