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posted on 19 December 2017

Issues And Challenges In Measuring And Improving The Quality Of Health Care

from the Congressional Budget Office

-- this post authored by Tamara Hayford and Jared Maeda

Efforts to measure and improve the quality of health care have proliferated in recent years. Many payers now require providers to report on quality as a way to make them accountable for their performance. Some states and other third parties have also developed programs to monitor and report on provider quality.

Those initiatives use various quality measures and incentives to encourage providers to follow evidence-based guidelines, enhance patients’ experiences, and improve clinical outcomes. This paper provides an overview of the current state of quality measurement and discusses the key issues and challenges in measuring provider quality and designing programs to improve it.

Understanding the challenges in both measuring the quality of health care and developing programs to improve it has become increasingly important for the Congressional Budget Office, because many policymakers seek to reorient federal programs toward paying for the value rather than just the volume of health care services. For example, Medicare has already implemented numerous programs designed to improve the quality of care, including those that simply measure the quality of care delivered by particular providers and report that information to beneficiaries and those that modify the payments to providers on the basis of their measured quality. Moreover, Medicare intends to significantly expand the proportion of services that are provided through alternative payment models in which payments to providers depend partly on their quality or in which those payments depend on a combination of providers’ performance on quality, resource use, clinical improvement activities, and the use of electronic medical records to report on measures.

Such efforts could have important effects on the quality of care received by Medicare beneficiaries and on Medicare spending under current law or future proposals - and could have broader effects on the U.S. health care system. However, those efforts could also have unintended consequences, such as encouraging providers to improve their ranking by avoiding sicker patients.4 In this paper, we discuss the issues and trade-offs inherent in developing quality measures and implementing quality improvement initiatives, using programs developed by Medicare to illustrate those concepts.

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