Econ Exam 3

  1. Quality indicators
    a measure that summarizes structure, processes or outcomes
  2. Guideline
    systematically developed statements assisting practitioner and patient decisions prospectivly for specific clinical circumstances.
  3. Indicator
    measurable element of practive performance for which there is evidence or that it can be used to asses quality of care provided.
  4. National committee of quality assurance
    • 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
  5. Characteristics of a quality indicator
    • face validity
    • acceptability
    • feasibility
    • reliability
    • sensitivity to change
    • predictive ability
  6. Face validity
    • demonstrates evidence
    • represents the concept being assessed
  7. acceptability
    acceptable by those measuring or being measured
  8. feasibility
    consistent, reliable, valid data available to construct the QI
  9. Reliability
    reproducible findings whin multiple organizations collect it
  10. Sensitivity to change
    can it detect change in the quality of care
  11. predictive ability
    can it predict quality of care outcomes
  12. Delphi Process
    convening expert panel to review and make decisions
  13. Quality indicators are metrics that
    capture the rates of processes of care at a health care organization
  14. Quality indicators are distinct from other performance indicators or guidelines because they
    infer the level of quality at an organization
  15. Quality indicators are built using...
    an extensive process of literature reviews and consensus
  16. Quality indicators are used for research purposes in....
    identifying disparities in care
  17. Quality indicators are used by health care organizations for...
    reporting and reimbursement purposes
  18. Information from MCOs and Hospitals are submitted to CMS...
  19. CMS audits and posts results on...
    Hospital Compare website
  20. CMS computes bonuses base upon....
    predetermined algorithms
  21. Challenges in reporting quality scores
    • abstracting the info from clinical records
    • annual changes in HEDIS quality measures
    • CMS auditing process
  22. Objectives of the GAO report
    • how hospitals collect and submit quality data
    • how CMS works to ensure reliability of the data
  23. Selected findings of the GAO report
    • 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
  24. Implications reported by the GAO
    • increase resources needed for quality indicator processing and reporting
    • risks of erroneous data
    • opportunities for health IT
  25. Definition of pay-for-performance
    a provider reimburement system that rewards providers based upon achiving pre-determined benchmarks of care.
  26. Goals of P4P
    create financial incentives in order to improve quality of health care delivery
  27. Outcomes of P4P
    • increased transparency
    • increased accountability
    • decreased costs?
  28. Considerations in designing P4P
    • 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
  29. P4P incentive systems
    • relative rank
    • relative rank with penalties
    • target attainment
    • target attainment plus improvement
    • percentage recomendation
  30. Relative rank
    rank order based upon performance
  31. Relative rank with penalties
    • rank order based on performance
    • reward top 2, punish 5th
  32. Target attainment
    hit benchmark (yes/no)
  33. Target attainment plus improvement
    • hit benchmark (yes/no)
    • historical performance taken into consideration
  34. Percentage recommended
    proportion of patients receiving recommended care
  35. Ideal P4P systems
    • reward for high quality
    • give all providers incentives
    • create a payment gradient that is sufficient to change provider behavior
  36. Pros of relative rank
    • advantage to top performers
    • high gradient
  37. cons of relative rank
    little incentive for low performances to improve
  38. Target Pros
    can achieve one area to compensate for deficiencies in another area
  39. Target cons
    • little incentive to improve beyond target
    • little incentive for low performers
  40. Percentage pros
    allows all to improve
  41. percentage cons
    may encourage overutilization
  42. Advantages of Pay for performance system
    • transparency
    • accountability
    • standardization
    • consumer choice
    • aligns incentives
  43. disadvantages of pay for performance systems
    • provider buy-in
    • feasibility
    • linked to outcomes?
    • financial burden
    • insufficient auditing
    • potential inequality or disparities
    • misaligned incentives
Card Set
Econ Exam 3
Reimbursement Approaches to improve quality of health care delivery