Even as a healthcare professional, understanding the what, when, why, who, and how of healthcare quality measurement becomes a grueling task. There are multiple non-profit and private sector organizations involved in the discovery, design, and verification of quality measures for the healthcare industry. We explain a bit of the who, what, why, when, and how behind quality care.
The Joint Commission (TJC)
Being the most well-known, hospitals and health systems all maintain TJC accreditation regarding their clinical care processes, ability and performance on specific quality measures and standards of care. TJC has been involved in performance measurement since the mid-1980s and launched its ORYX initiative in the late 1990s as the first national program for measurement of hospital quality. TJC has established standardized core performance measure sets for hospital operations and contributes to the national strategy for improving healthcare quality transparency. The Joint Commission can also be found at the forefront of new programs such as MACRA/MIPS.
Centers for Medicare and Medicaid Services (CMS)
CMS mandates the reporting of quality measures by hospitals, physicians, and providers of other healthcare products and services. CMS’s Measures Management System provides a standardized process for ensuring that CMS will have a rational, conspicuous system to measure the quality of care delivered to recipients. This system was developed in coordination with the other organizations mentioned in this post. CMS collaborates with private, nonprofit organizations such as The Joint Commission and the American Medical Association to create quality measures necessary for regulatory compliance, including the Hospital Outpatient Quality Data Reporting Program, the Physician Quality Reporting System, and Hospital Compare.
National Committee for Quality Assurance (NCQA)
The NCQA is one of the main certification and accreditation organizations for patient-centric medical home initiatives, health plan accreditations, disease and case management, and other healthcare provider certification and recognition programs. The NCQA provides and governs the development of the Healthcare Effectiveness Data and Information Set (HEDIS) ambulatory care measures.
National Quality Forum (NQF)
The NQF has a focus on building consensus on national healthcare goals and priorities for quality measurement and performance improvement, being the industry’s leading endorsement organization for the development and approval of quality measures. As new quality measures are developed and tested, the NQF plays a vital role in validating measures prior to official use and implementation.
American Medical Association (AMA)
The AMA, a national association for physicians, convened the Physician Consortium for Performance Improvement (PCPI) in 2000. Since then, the PCPI has grown to include participants from various organizations and has identified copious measures spanning multiple measure sets. The PCPI is continually working to develop measures on patient-centric care.
Agency for Healthcare Research and Quality (AHRQ)
AHRQ is an entity within the U.S. Department of Health and Human Services that provides a clearinghouse for quality measures, coordination of evidence-based best practics, and annual reportings of national clinical quality measures. AHRQ also manages the Consumer Assessment of Healthcare Providers and Systems (CAHPS) patient satisfaction surveys.
Utilization Review Accreditation Commission (URAC)
The URAC is a healthcare quality accreditation organization for health plans, provider organizations, and physician practices with various accreditation and certification programs. These programs include healthcare utilization reviews, patient-centered healthcare homes (PCHCH), pharmacy benefits management, healthcare website maintenance, claims management, and disease management to list a few. These accreditations serve an important purpose for insurance commissioners, state and federal legislators, employers, and consumers because they are a sign of a high quality and represent the organization’s ability to meet agreeable performance metrics levels.
Since these quality measure reportings are mandated by government regulations, the ability to harmonize these measures has become an important discussion topic. These mandated reportings may ultimately contradict internal quality improvement efforts focused on different measures. These different metrics may have overlapping population segments, track performance for supporting or competing quality measurement organizations, or require seemingly identical measures of conditions or diseases but utilize different data, exclusions, numerators, or denominators. Having an understanding of these organizations is critical in healthcare, so if you have questions, reach out to us directly, tweet us, or provide us your contact information to the right. We’ll solve your problem so you can focus on your solution.