Econ Exam 3

a measure that summarizes structure, processes or outcomes

systematically developed statements assisting practitioner and patient decisions prospectivly for specific clinical circumstances.

measurable element of practive performance for which there is evidence or that it can be used to asses quality of care provided.

• non for profit dedicated to improving health care quality
• provides accreditation to health care organizations
• builds and updates halthcare effectiveness data and information set tool

• face validity
• acceptability
• feasibility
• reliability
• sensitivity to change
• predictive ability

• demonstrates evidence
• represents the concept being assessed

acceptable by those measuring or being measured

consistent, reliable, valid data available to construct the QI

reproducible findings whin multiple organizations collect it

can it detect change in the quality of care

can it predict quality of care outcomes

convening expert panel to review and make decisions

capture the rates of processes of care at a health care organization

infer the level of quality at an organization

an extensive process of literature reviews and consensus

identifying disparities in care

reporting and reimbursement purposes

quarterly

Hospital Compare website

predetermined algorithms

• abstracting the info from clinical records
• annual changes in HEDIS quality measures
• CMS auditing process

• how hospitals collect and submit quality data
• how CMS works to ensure reliability of the data

• challenges locating data
• scope required for a data element slows collection rate
• incorporating changes in HEDIS measures
• no ongoing process for ensuring completeness of quality of data

• increase resources needed for quality indicator processing and reporting
• risks of erroneous data
• opportunities for health IT

a provider reimburement system that rewards providers based upon achiving pre-determined benchmarks of care.

create financial incentives in order to improve quality of health care delivery

• increased transparency
• increased accountability
• decreased costs?

• are bonuses sufficient to change provider behavior?
• what are the administrative costs of reporting quality scores?
• Does your practice have sufficient expertiese and infrastructure to collect data to report to CMS

• relative rank
• relative rank with penalties
• target attainment
• target attainment plus improvement
• percentage recomendation

rank order based upon performance

• rank order based on performance
• reward top 2, punish 5th

hit benchmark (yes/no)

• hit benchmark (yes/no)
• historical performance taken into consideration

proportion of patients receiving recommended care

• reward for high quality
• give all providers incentives
• create a payment gradient that is sufficient to change provider behavior

• advantage to top performers
• high gradient

little incentive for low performances to improve

can achieve one area to compensate for deficiencies in another area

• little incentive to improve beyond target
• little incentive for low performers

allows all to improve

may encourage overutilization

• transparency
• accountability
• standardization
• consumer choice
• aligns incentives

• provider buy-in
• feasibility
• linked to outcomes?
• financial burden
• insufficient auditing
• potential inequality or disparities
• misaligned incentives