How is care quality measured?

How is care quality measured? October 8, 2018

Quality is not as easily measured as quantity. Terms like value-based care and quality care are increasingly used by healthcare providers as well as the Centers for Medicare & Medicaid Services (CMS) and even private healthcare payers. Measuring this care has become an integral part of the reimbursement and incentive system, particularly in the case of Medicare, but the question of how to measure quality care may not be clearly resolved for many providers.

CMS has launched a new Meaningful Measures Initiative to help define quality measures for healthcare providers. The Meaningful Measures areas are each linked to specific CMS strategic goals and, in fact, “serve as the connectors between CMS strategic goals and individual measures/initiatives that demonstrate how high quality outcomes for [CMS] beneficiaries are being achieved.”

Nineteen Meaningful Measure areas include such measures as Alcohol Use Screening, Use of Opioids at High Dosage, and Influenza Immunization Received for Current Flu Season, aligning with the CMS goal to Promote Effective Prevention and Treatment of Chronic Disease, for example. These areas have been divided into six quality categories as part of the Meaningful Measures Initiative:

1.       Promote Effective Communication and Coordination of Care
2.       Strengthen Person and Family Engagement as Partners in their Care
3.       Promote Effective Prevention & Treatment of Chronic Disease
4.       Work with Communities to Promote Best Practices of Healthy Living
5.       Make Care Affordable
6.       Make Care Safer by Reducing Harm Caused in the Delivery of Care

In addition, six cross-cutting criteria are applied to any Meaningful Measure area:

1.       Eliminating disparities
2.       Tracking to measurable outcomes and impact
3.       Safeguarding public health
4.       Achieving cost savings
5.       Improving access for rural communities
6.       Reducing burden

While quality can be a subjective term, particularly when it comes to measuring healthcare quality, CMS emphasizes that its new Meaningful Measure Areas are “concrete quality topics, which reflect core issues that are most vital to high quality care and better patient outcomes.”