Nancy Clarke Thomas Syltebo “Am I Doing This Right? Quality Measurement and Standards of Care

Which car do you want? $48,000 $14,500

Which hospital do you want for your bypass graft surgery? Salem Hospital Legacy Good Samaritan Hospital

Source: Oregon Office of Health Policy and Research website,

Source: Oregon Office of Health Policy and Research website,

Association between Medicare spending and quality ranking -- U.S. States Baicker and Chandra, Health Affairs, web exclusives Oregon New Hampshire Texas

Market forces don’t work in health care Very little information is available about either quality or cost Higher quality is often LESS expensive Entrepreneurs are filling a vacuum in misleading ways Problem

With increasing expectations, Medicine has been required to demonstrate Quality Impact --- creation of a new industry Quality Measurement Am I Doing This Right?

Focus of Measurement Clinical Quality Service Quality (patient experience) Cost and Efficiency Dimensions of Measurement

Locale of Care Primary Care Specialty Care Hospital/Institutions (ie. Nursing Homes) Ancillary Services (ie. Ambulance) Public Health Dimensions (con’t)

Measurement Types Structural Process Outcome Dimensions (con’t)

Data Source Claims/administrative Surveys (ie. Pt experience) Encounter (chart review and EHR) Special registries Population data/vital statistics Dimensions (con’t)

Depends on the Entity and its accountability within the Health Care System These Entities divide into External to the actual care process and Internal First the External Entities Why Measurement?

Accountability for Public Safety – Regulators State Boards (ie. Medicine, Nursing, Pharmacy, Chiropractic) CMS for Medicare and Medicaid Oregon Public Safety Commission Why Measurement?

Accountability for Payment – Purchasers (Public and Private, moving towards coalitions) Oregon Health Authority CMS Health Plans (local/regional vs. national) Oregon Coalition of Health Care Purchasers Why Measurement?

Accountability for Professional Standards Specialty Societies and Boards “Organized” Medicine (ONA, OMA, AMA) Why Measurement?

The “Public” (small but growing) Oregon Health Care Quality Corp Citizen members on State Commissions and Committees Patient Advisory Councils Angie’s List Why Measurement?

Internal – Providers of Care Process improvement for efficiency Market differentiation (we’re #1!) Altruism/wanting to do the right thing Risk management Enhanced payment (P4P) Why Measurement?

National Players National Quality Forum NCQA – HEDIS The Joint Commission CMS – Hospital Process of Care; “Never Events” AHRQ – Prevention Quality Indicators National Hospital Inpatient Quality Measures Consumer Reports National Priorities Partnership Quality Measurement Industry

Patient Experience of Care - National Press-Ganey, Picker, Sullivan-Luallin CAHPS, H-CAHPS Patient Activation Measure Quality Measurement Industry

22Partner for Quality Care is an initiative of the Oregon Health Care Quality Corporation

23Partner for Quality Care is an initiative of the Oregon Health Care Quality Corporation

Local/Regional Quality Corp Oregon Health Authority Committees * Health Incentives and Outcomes * Health Improvement Plan * Health Information Technology * Patient-centered Primary Care Home Standards Advisory Quality Measurement Industry

Dilemmas Risk Adjustment Doesn’t do enough to address cost Small “N” challenges Focuses on distinct entities but many problems relate to transitions With fragmentation, each organization has its own measures, guidelines, and process Is This Enough?

Legal Issues Arise Quality Standard Definition Feed back to Providers Publicly Reported Scores Steering Tiering & Payment Privilege and Exclusions

"Patient Charter" for Physician Performance Measurement, Reporting and Tiering Programs

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