Quality Health Care or Good PR?

by Cathy Miller on May 10, 2011

in Health Care Legislation, Health Care Reform

Merriam-Webster defines quality as –

  • A degree of excellence
  • A distinguishing attribute

The challenge in delivering quality health care is making life and death decisions – literally.

Quality-based Payments

Healthcare reform’s Affordable Care Act changes quality of care from a mere reporting requirement into a basis for provider payments.

The Centers for Medicare & Medicaid Services (CMS) issued the final rule for the Hospital Value-based Purchasing Program. The program begins in 2013 and applies to payments for hospital discharges of Medicare beneficiaries that occur on or after October 1, 2012.

CMS issues payments to acute care hospitals, based on the following:

  • How well the hospitals perform on certain quality measures; or
  • How much the hospital’s performance improves
  • The higher the performance or improvement – the higher the incentive payment

There is a proposal from CMS for a 70 percent weight for clinical process of care and 30 percent for patient care experience. Data from various programs will be factors in the measurement. In the first year, 12 quality measurements include the following categories:

  • Heart attack
  • Heart failure
  • Pneumonia
  • Surgical care
  • Healthcare-associated infections

Defining Quality

Process of care measurements assess how well healthcare providers follow guidelines, standards of care or practice parameters when delivering care. The measurement for patient care experience comes from survey results from the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey.

A recent article in The Hospitalist identifies some of the flaws in the measurements. For example, prescribing heart medication doesn’t guarantee the patient fills the prescription; therefore, how accurate is the prescription as a measurement for a positive outcome?

The HCAHPS has 27 questions about a patient’s hospital experience. It gathers information on the patient’s perspective regarding –

  • Courtesy and respect from nurses and physicians,
  • Communication with nurses and physicians
  • The physical environment of the hospital
  • Pain care management and medication

Measuring quality of care is a combination of evidence-based medicine, clinical guidelines and the very human element of patient satisfaction. Quantifying all that is no easy task.

BigStock Photo credit

Notice of Disclaimer –Cathy Miller is not an attorney or health care professional and cannot provide legal or medical advice. The information provided is for your general background only, and is not intended to constitute legal or medical advice as to your specific circumstances. We recommend you review legal issues with an attorney and medical issues with your physician.


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{ 2 comments… read them below or add one }

Howard Katz May 14, 2011 at 9:49 am

You write, “Measuring quality of care … is no easy task.”

True, it’s not easy, but it’s doable. It doesn’t have to be perfect, just good enough to replace bill-for-service with advance-payments-to-maintain-the-group’s-health (aka global payments).

Not perfection, just good enough. That’s doable.

Howard Katz
Jamaica Plain, MA
Technical Writer. Grant Writer. Advocacy Writer.


Cathy May 14, 2011 at 11:05 am

Hi Howard: I agree it doesn’t have to be perfect, but the jury is still out on the different delivery care models. Thanks for stopping by and sharing your view.


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