Medicare Quality Initiatives Analysis

CMS establishes policies for the provider reimbursements, researches healthcare management and treatments, and continually asses the quality of facilities and services.

What do you consider to be the key issues for quality improvements in the NHS quality-improvement program as it goes forward?

Outcome based processes geared towards improving outcomes by implementing performance improvement checks on all complaints or negative feedback acquired from patients, healthcare providers, employees, vendors (all stakeholders) and environment of care rounds. These would include QC measures, infectious control measures, ACC measures, HCAP measures to name a few. Align with nationally recognized locators for healthcare facilities to compare our organization with local and nationally recognized healthcare organizations to see where we rank. Strategic goals established by The Joint Commission and initiatives by CMS will help improve overall performance.

Since the late 1980s, Medicare has reimbursed physician services using the Medicare Physician Fee Schedule (MPFS), which encompasses 10,000 procedure codes. Each code is assigned resource-based relative value units (RVUs), which are designed to reflect physician work, practice expense, and malpractice expense. To adjust for local differences in cost of living, each RVU is modified using geographic practice cost indexes (GPCIs) and then converted to dollars using a “conversion factor.” This system rewards physicians who produce a high volume of services; not surprisingly, Medicare Part B expenditures have grown rapidly.

Quality Improvement Organizations (QIOs), work in partnership with the Centers for Medicare and Medicaid Services (CMS) to advocate for safe, efficient, and quality healthcare for Americans. Working at the community level, QIOs collaborate with providers and interact with beneficiaries to improve patient outcomes. Additionally, QIOs support new models of care and promote healthcare goals endorsed by the National Quality Strategy, and CMS Quality Strategy. CMS has strategically placed QIOs in several regions nationwide, and Mississippi is served by Information and Quality Healthcare (IQH). IQH founded in 1971 as a non-profit organization has strived to improve the quality of care received in Mississippi. IQH participates in a tobacco cessation helpline, behavioral health services, and diabetes education for Medicare beneficiaries.

The home page website claims the website promotes information for “better care, better health and lowering healthcare costs” ("Cms.gov centers for”). The website was developed to educate the public about CMS benefits and legislative and public affairs. The website provides contact information that is readily available to the viewer.

The Affordable Care Act (ACA) is a federal health reform legislation engineered to provide Americans with high quality, affordable cost and better access to health care [1]. To address these overarching aims, the ACA requires the secretary of the Department of Health and Human Services (HHS) to establish a National Strategy for Quality Improvement in Health Care, also known as the National Quality Strategy (NQS) [2]. The strategy sets three aims. First, to make health care more reliable,

Quality management is essential to the success of the quality improvement of the health care industry. “Management uses management and planning tools to organize the decision making process and create a hierarchy when faced with competing priorities “( Ransom, et al., 2008). Quality measures should have these goals: effective, safe, efficient, patient-centered, equitable, and timely care (Quality Measures, Center for Medicare & Medicaid Services, 2011).

Affordable Care Act requires that all skilled nursing care centers develop Quality Assurance and Performance Improvement programs. The statute requires the Centers for Medicare & Medicaid Services (CMS) to develop a prototype QAPI program, establish standards, and provide technical assistance to centers on the development of best practices in order to meet such standards.

Topic 1 - Part 1 There are several reasons for quality initiatives, particularly as they pertain to Medicare and Medicaid. First, quality initiatives impact every aspects of healthcare and the manner in which quality and efficiency are delivered and combined. Second, successful quality initiatives impact the way the public sees healthcare and the manner in which government can help impact the delivery to the majority of citizens. The are a standardized approach for the development and most especially, the measurement, of quality. The focus and idea is that if you do not measure it, it won't measure up to standards. There are 15 of these steps that directly impact care; from the development and definition of a plan, through committees and panels, then finally through the approval and implementation process. Essentially, this is a set of tools that are used to both standardized and improve care.

Do you have some durable medical equipment, prosthetics, orthodics or associated supplies (DMEPOS) in your medical office supplied by a home medical equipment (HME) supplier? Such an arrangement is often called a loan or consignment closet.

This was evident by one manager who told me that since the adoption of their tele-ICU system, they had been able to implement many more quality-of-care initiatives in their ICUs -- and to update their quality-improving protocols much more frequently. This intertwining of the technology with the clinical quality improvement initiatives makes evaluating the effects of the technology more challenging. But having interviewed senior tele-ICU managers, and studied health system transformation and quality improvement, I believe that such multidimensional analyses and thinking are crucial for appreciating what is required for delivery system reform to improve both quality and cost-efficiency.

Quality measures are strategies that gauge, evaluate or compute health care processes, results, discernments, patient insight, and administrative structure. In addition, quality measures are frameworks that are connected with the capacity to deliver first-class health care and/or that are able to identify with one or more quality objectives for medicinal services. These objectives include: compelling, protected, effective, quiet focused, impartial, and opportune consideration. Quality measures can be used to measure quality improvement, public reporting, and pay-for-reporting programs specific for health care providers (CMS.gov, 2016). There are an assortment of quality measures in which health care organizations can use to determine the status of the care they are delivering. Many are appropriate, but few are chosen for this research paper. Among them are: National Health Care Surveys, Hospital IQR Programs, Scorecards, and Political, Power, and Perception/Data for Decision-making tools.

Examining planning for and effectively measuring the health care quality indicators make healthcare quality more transparent and provide information for quality improvement programs and initiatives in the healthcare system.

-Examine at least three (3) examples of quality initiatives that could increase patient satisfaction and potentially reduce healthcare cost. Support your response with examples of the successful application your chosen quality initiatives.