Quality Improvement

Quality Improvement

Health care quality improvement is a motivating force behind many of the provisions of the ACA relating to delivery and payment reforms. Specific quality improvement initiatives authorized by the ACA include the following:

  • Direction to HHS to establish and update annually a national strategy for improving health care service delivery, patient health outcomes, and population health.
  • Requirement for the President to convene an Interagency Working Group on Health Care Quality to coordinate federal agencies’ quality improvement efforts consistent with the national strategy.
  • Various funding authorizations and directives to federal agencies for developing and endorsing quality assessment measures and clinical practice guidelines.
  • Requirement that HHS establish and implement a strategic framework for collection of quality and resource use data and public reporting of performance data.
  • Establishment and funding of a private, non-profit corporation – Patient-Centered Outcomes Research Institute (PCORI) – to conduct comparative effectiveness research.
  • Appropriation of funds for the Agency for Healthcare Research (AHRQ) to award research grants to develop, evaluate, disseminate and train on best practices in health care delivery and quality improvement.
  • Implementation of a quality reporting program for inpatient rehabilitation facilities, hospice providers and long-term care facilities.

Most of HHS’s quality improvement responsibilities will be carried out under the aegis of AHRQ and will involve collaboration among federal agencies and private entities. To date, implementation of the ACA’s provisions on quality improvement include the following:

  • PCORI was established in 2010 and has awarded over $40 million in funding for patient-centered outcomes research.
  • In March 2011, HHS issued a Report to Congress outlining the National Strategy for Quality Improvement in Health Care, which sets six priority areas for quality improvement and describes a strategic plan for achieving these priorities. In April 2012, HHS issued a subsequent report describing how it will pursue and measure the six priority areas and detailing its long-term goals within each priority area.
  • An Interagency Working Group on Health Care Quality first convened in March 2011 and included representatives from 24 federal departments and agencies with quality-related missions. In 2012, it focused its efforts on exploring 1) lessons learned from expanding Federally Qualified Health Centers; 2) the U.S. Department of Veterans Affairs’ ASPIRE reporting initiative; 3) disseminating better information to consumers; and 4) potential new applications of the Baldrige Framework – the nation’s public-private partnership dedicated to performance excellence.
  • On May 6, 2011 CMS issued a final rule establishing a Hospital Inpatient Value-Based Purchasing program, which pays hospitals value-based incentive payments if the hospital meets certain performance standards.
  • On June 6, 2011, CMS issued a final rule that prohibits federal payments to states under section 1903 of the Social Security Act for any amounts expended for providing medical assistance for certain health care-acquired conditions. Under the final rule, states are authorized to identify other provider-preventable conditions for which Medicaid payment will be prohibited.
  • In August 2011, HHS issued final rules on the quality reporting programs for inpatient rehabilitation facilities, hospice providers and long-term care facilities, which are included in the respective prospective payment system rulemakings for these providers.
  • On August 18, 2011, CMS issued a final rule updating the Prospective Payment System and describing the Hospital Readmission Reduction Program, which will reduce hospital payments under section 1886(d) of the ACA to account for certain excess readmissions.
  • In December 2011, HHS issued a final rule on the release and use of Medicare claims data by “qualified entities” to measure the performance of Medicare providers and suppliers.
  • In final regulatory actions on January 4, 2012 and August 19, 2013, CMS separately released quality metrics for the provision of care to Medicaid-eligible adults and the final Medicare quality reporting rules for specific providers.
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