The Joint Commission has implemented several changes to show quality and performance improvements. First it has expanded the performance measurement requirement for accredited general surgical/medical hospital from four core measures sets to six (The Joint Commission, 2014). This change was implemented from January 2014.According to the new performance measurement, out of the six measure sets, four are mandatory for the hospitals that serve special patient populations addressed by both the measure sets as well as the related measures (The Joint Commision., 2014). For hospitals that experience more than 1100 births annually, a fifth measure set will be mandatory, and this particular set is the perinatal care measure. General hospitals will be allowed to choose their preferable sixth measure set from an approved list of measure sets. Hospitals with less than 11100 births per year will in actual sense be allowed to choose both the 5th and 6th set since the previously mentioned fifth set (perinatal care measure) will not be imposed on them (The Joint Commision., 2014). In line with this change in performance measurement, hospitals are expected to modify and also update their measure set selections approximately two months before the commencement of data collection.
The Center for Medicare and Medicare Services has enacted changes by re-designing its QIO (Quality Improvement Organization) program to enhance the quality of services positively for the beneficiaries of Medicare. The new and restructured quality improvement program maximizes collaboration and learning in improving care, supports the use and spread of efficient new models and practices of care, enhances flexibility, delivers program value to patients, beneficiaries and taxpayers, and finally helps in the achievement of the National Quality Strategy priorities as well as the CMS Quality Strategy goals (Centers for Medicare and Medicaid Services, 2014). Some of the primary program, changes that have been effected include the separation of case review and quality improvement, extension of contract period of performance from three years to five years, the removal of the requirement that QIO activity is restricted to one entity in each territory or state and finally the opening of the contractor consideration to a vast range of bodies or entities to perform the particular work (Centers for Medicare and Medicaid Services, 2014).
The National Committee for Quality Insurance has enacted several changes in performance measurement. One of these changes is the change onfthe rating system from 0-100 to 0-5. The new rating system will also include half point increments that were not there in the previous system. The new system also stipulates that all plans must have rates that are valid for at least half of the measures when it comes to ratings by weight (National Committee for Quality Assurance, 2014). The National Committee for Quality Insurance has also enacted a new approach when it comes to measuring quality. This approach provides a more sensitive scaling of risk factors. In addition, it this new approach will make it possible medical providers to create more clinically meaningful incentives in improving disease prevention (National Committee for Quality Assurance, 2014). This tool mainly focuses on improving medical outcomes for diabetes and heart disease paint and is titled ‘The Global Cardiovascular Risk” (GCVR) score.
The Utilization Review Accreditation Commission (URAC) has also enacted changes by introducing new reporting standards as well as performance measures on its Drug Therapy Management (DTM) as well as its Pharmacy Benefit Management (PBM) accreditation program (Utilization Review Accreditation Commission, 2014). One of these changes, for instance, is the altering of the measurement reporting to an approach that is multi- year three-phased (Utilization Review Accreditation Commission, 2014). The first phase requires organizations to report to URAC the mandatory measures with particular focus on oversight activities as well as internal performance improvement. The second phase will involve the verification or auditing of those measures after which URA will then avail composite measurement data to all participating organizations. The final phase will involve the publishing of detailed public reports on the body’s website where specific information on each organization will be provided (Utilization Review Accreditation Commission, 2014).
References
Centers for Medicare and Medicaid Services. (2014). Quality Improvement Organizations - Centers for Medicare & Medicaid Services. Retrieved from http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityImprovementOrgs/index.html?redirect=/qualityimprovementorgs/
The Joint Commision. (2014). Performance Measurement and Improvement for Disease-Specific Care Certification Programs | Joint Commission. Retrieved from http://www.jointcommission.org/performance_measurement_and_improvement_for_disease-specific_care_certification_programs/
National Committee for Quality Assurance. (2014). Performance Measurement. Retrieved from http://www.ncqa.org/HEDISQualityMeasurement/PerformanceMeasurement.aspx
Utilization Review Accreditation Commission. (2014). URAC - URAC Introduces New Performance Measures and Reporting Standards for Pharmacy Benefit Management and Drug Therapy Management Accreditation. Retrieved from https://www.urac.org/news/urac-introduces-new-performance-measures-and-reporting-standards-for-pharmacy-benefit-management-and-drug-therapy-management-accreditation/
