Defining Quality Care
What is Quality Care?
The Institute of Medicine (1990) defines quality care as the “degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.”
How Do We Know We Are Providing Quality Care?
We take part in continuous quality improvement which includes:
- Establishing quality metrics
- Understanding how to measure performance
- Collecting data
- Establishing baseline performance levels
- Reviewing and evaluating data
- Determining where improvements can be made
- Re-measuring and re-evaluating data
Why Collect Data?
Data drives improvement for our patients
- Reviewing performance measures allows adjustments in care, sharing successes and probing for causes when progress comes up short
Data informs consumers
- A growing number of measures are publicly reported
- Consumers have access to make informed choices about their care
- More providers are posting performance measures on their websites on national sources such as Hospital Compare and Nursing Home Compare.
Data influences payment
- Private and public payers use measures as preconditions for payment and targets for bonuses
- CMS offers payment incentives under the Physician Quality Reporting System (PQRS) for reporting quality measures. Potential incentives for 2013 and 2014 are 1%.
- CMS has potential penalties under PQRS for 2013 and 2014 of between 1.5% and 2% for not reporting quality measures.
Data proves our value and drives appropriate referral to the subspecialty
- Despite studies that demonstrate improved surgical outcomes in women with ovarian cancer when they are managed by a gynecologic oncologist, many women with ovarian cancer are not referred to the appropriate specialists.
- Hospital credentialing and reimbursement policies must be changed to discourage providers that do not have specialty training in gynecologic oncology from providing care to women with gynecologic cancer.