Understanding Clinical Quality Measures and What Impacts it

Clinical quality measures are a major factor when you aim at quality improvement. Quality improvement is a systematic and deliberate approach towards improving the quality of healthcare in measurable ways. Quality improvement in the healthcare industry is an ongoing effort to make the process better that has picked up in relevance in recent times like never before. Improving quality is making healthcare safe, timely, patient-centered, effective, efficient and equitable. Researchers and health practitioner constantly find ways to maximize quality improvement and understand the variable that comes into play while seeking to achieve certain quality goals. They seek to answer the question: What Can Impact Clinical Quality Measures?

They seek to know for quality improvement in healthcare, what are some defining principles that help health practitioners and health organizations process and navigate quality improvement. Some of these principles will be discussed below. Clinical quality measures help measure various aspects of patient care. Some of these aspects include:

  • health outcomes
  • clinical processes
  • patient safety
  • efficient use of healthcare resources
  • care coordination
  • patient engagements
  • population and public health
  • adherence to clinical guidelines

Measuring the quality of patient care helps to drive improvements in healthcare. Specifically, measuring the quality of patient care with CQMs can:

Identify Areas for Quality Improvement

First, the hospital or healthcare organization needs to identify what areas of their organization are lacking in quality and need improvement. This identification process helps create a priority list of a sort which helps better focus resources.

Identify Differences in Care/Outcomes Among Various Populations

These differences once identified, will help the healthcare organization know which areas again t focus resources on.

Improve Care Coordination Between Health Care Providers

When care is coordinated, it makes away with redundancies and mistakes which improve clinical qualities.

The Use of Electronics/Technology

If the challenge of preparing for accurate electronic clinical quality measure reporting seems to be creating yet another grey cloud on the horizon, let me point out a few silver linings.

  • Using the e-measure model to report clinical quality measures will reduce the abstraction burden for physicians and hospitals, which is welcome news indeed! This would allow redeployment of valuable clinical resources from low-value data capture to high-value analysis and improvement activities.
  • With the move to e-measures, CMS and other agencies will be able to more quickly align and harmonize the quality reporting requirements of various programs and remove duplicative reporting burdens for hospitals and physicians.
  • Once data integrity issues are resolved, healthcare providers will be left with a far richer data set that can deliver value in a number of ways: robust clinical decision support rules, improved service line analytics, and improved readiness for future e-measure reporting requirements.
  • There can be little doubt that the use of electronic clinical quality measures will accelerate as EHR technologies and standards continue to mature. A robust data governance program will help you prepare for – and take advantage of – this transition in quality reporting.

While e-measure reporting has been mandatory for Meaningful Use, it has so far been voluntary for other quality reporting programs. This may soon change; in the Inpatient Prospective Payment System (IPPS) proposed rule published in April, CMS is proposing that e-measures be the required reporting method for the HIQRP program as of the calendar year 2016.

If this proposal makes it to the final Acute inpatient PPS rule in August, hospitals will have a clear deadline by which e-measure accuracy issues must be found and resolved. Given that the HIQRP e-measures would be audited for accuracy, publically reported, and eligible for inclusion in the Value-Based Purchasing program, accurate e-measure reporting becomes of paramount importance. Hospitals will want to use the next several months to assess each e-measure data element for reliability and precision as part of a larger data governance program. Remember, inaccurate HIQRP reporting can result in the loss of the Medicare annual payment update hospitals receive for participating in this program.