The concept of Clinical quality measures refers to tools used to measure and track the quality of healthcare services provided by eligible professionals, eligible hospitals, and critical access hospitals within the healthcare system. In recent times, healthcare reporting has been shifting more and more to the use of electronic clinical quality measures because of its usefulness. However, as quality measures are important, so is the need to manage these measures properly. Below are some ways you can manage clinical quality measure
Involve the right people:
For starters, include financial and clinical leadership—the former so they can budget based on performance in these programs and the latter to track and monitor performance, and deliver the outcomes improvement work. This includes the department within an organization that is responsible for payer contracting. A strong connection with this team is critical to set quality measure goals with commercial payers that align with the efforts required of government programs.
Additionally, involve frontline nursing staff. I had an interesting conversation with a clinical nurse specialist who had attended classes for frontline nurses to explain the rationale behind certain measures and why they were being asked to document in a certain way. Until I met with her, I underestimated how much frontline staff value understanding this rationale.
Work with physicians to define and align internal measures with publicly reported measures. This has multiple benefits: optimized patient care, and improved forecasting and monitoring of performance in programs like the IQR.
Get involved in measure development upstream:
It’s easy to feel helpless with the growing torrent of required measures rushing down the pipeline every year. It seems the only choice is to find a way to work on all of them. However, healthcare systems can impact the rules that guide the approval of measures and payments by CMS (e.g., the Inpatient Payment Prospective System or the Physician Fee Schedule Rule). Before measure requirements are embedded into rules and assigned reimbursement amounts, they go through the Measures Under Consideration process and most measures are endorsed by the National Quality Forum.
The Measures Under Consideration process exposes all proposed measures for a 12-month period. This is the first opportunity for public comment and a way to impact rules far upstream. Then rules are released as proposed, which presents another period for public comment. These are two opportunities to work with your regulatory affairs team or government and public policy team to draft letters, including clinician feedback, to CMS. Feedback may not be incorporated 100 percent of the time, but change is affected by following this strategy and it is a process that gives a voice to healthcare organizations. Develop a feedback loop for selecting measures and rules. Everyone feels greater ownership when they are allowed input into the process. Create opportunities in the measure development cycle and how rules are adopted for people to provide feedback on measures. This ensures that measures dovetail into clinical priority areas.
Prioritize measures that truly impact patient care:
We all work to keep patients safe and improve their outcomes. Thankfully, we see trends in required measures shifting from process to outcome measures to align with this focus. Outcome measures, like mortality and readmission rates, are important. Additionally, patient safety measures, such as surgical site infection (SSI), Catheter Associated Urinary Tract Infection (CAUTI), and Central Line Associated Blood Stream Infection (CLABSI) are part of multiple pay-for-performance programs with considerable visibility. When complications arise, a surgery or procedure can end up with a different DRG depending on coding, and contribute to decreased reimbursement through both the CMS Value-Based Purchasing and Hospital-Acquired Condition (HAC) Reduction programs, and most importantly, worsen a patient’s satisfaction and health outcomes. Performing poorly on patient safety measures means not doing well by patients and leaving dollars on the table. So continue including patient safety and patient harm measures on your organizational scorecards, but be aware of how your internal goals align with benchmarks and thresholds identified in the pay-for-performance programs.