What is an ACO?
How Quality Reporting Can Degrade Clinical Quality Measures
Clinical quality measures, also known as CQMs, are used every single day in the medical field by professionals, including doctor's offices, critical access hospitals or CAHs, and nursing homes. Although patients don't tend to participate in CQMs personally, they are a crucial part of these measurements, which track all levels of patient care. From the moment that you enter a medical facility, all parts of your experience are recorded. This lets doctors, nurses, and other practitioners know that they are sufficiently caring for patients in a timely manner. However, the rate of information requested by some quality reporting programs can cause CQM lag.
What Are Clinical Quality Measures?
CQMs, as mentioned above, track a variety of different components as related to a patient's health during their time in a medical facility. These, according to the Centers for Medicare and Medicaid Services or CMS, include the following:
- Patient safety
- Speed of care
- Obeying clinical guidelines
- Rate of care
- Taking advantage of health care resources
- Using clinical processes
- Reporting good patient health before release
Without these, it would be hard if not impossible for doctor's offices, hospitals, and nursing homes to ensure that their patients are being cared for, especially when staff cannot possibly attend to all patients all the time in these facilities.
How Are Clinical Quality Control Measures Monitored?
Using e-measures for CQMs is preferable in today's nonstop world. Collecting this data electronically makes it easier to read and disseminate the information to the appropriate parties. That said, some medical facilities are only just making the move to using e-measures and may be relying on outdated means like paperwork to track this data.
The U.S. Department of Health and Human Services also employs what is called Stage 1 Clinical Quality Measures. Only certain eligible professionals or EPs can participate in this separate data program which, according to HRSA's website, refers to CQMs as "processes, experience, and/or outcomes of patient care, observations or treatment that relate to one or more quality aims for health care such as effective, safe, efficient, patient-centered, equitable, and timely care." See the chart below for how EPs can choose a Stage 1 CQM.
What Is Quality Reporting?
Quality reporting programs are typically requested by specialty groups and state agencies, but health insurance providers, like the Centers for Medicare and Medicaid Services, can also ask for this information. While participation in such programs is optional, those medical facilities that do opt to join in have to gather twice the amount of data. This is where something as powerful as the Electronic Health Record Incentive Program has helped participating organizations. The electronic gathering and verifying of data enables facilities to meet the rigorous new requirements and not be overwhelmed with the need to staff numerous new positions dedicated to data gathering.
These programs may be called Meaningful Use or MU programs, and they all strive to make the patient experience an even more positive one. It's possible for EPs to get a cash reward for participating in the programs, but they must follow all steps of the program very carefully and meet the standards required by each step. Failure to do so typically does not result in such a reward.
How Can Quality Reporting Degrade Quality Control Measures?
As one can imagine, with at least three steps to most programs, there is a lot of content and data for medical facility personnel to gather and sift through without the help of electronic methods. In the meantime, CQM reporting cannot slow down or cease, so now these personnel must work through twice the data that they normally would. This number can only grow depending on how many programs that the medical facility has decided to participate in during a calendar year. Human error is likely to prevail and information will get mixed up or other mistakes will be made. This could lead to disqualification from the program for failing to achieve all steps. It could also call the medical facility's credibility into question.
What Changes Can Be Made to Quality Reporting to Keep Quality Control Measures Accurate?
First of all, medical facilities that have yet to move to e-measures should certainly consider doing so. In April of this year, the Inpatient Prospective Payment System or IPPS made a new rule through the CMS that by 2016, when participating in the Hospital Inpatient Quality Reporting Program or HIQRP, that e-measures will be mandatory. Since e-measures are professionally audited before they are passed, this reduces the chances of making a mistake. If by chance human error did occur, the blunder could be fixed before the CQMs are approved, promoting accuracy and better medical facility transparency.
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- Written by Clinical Quality
- Category: Clinical Quality Measures
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