Is the performance of the health system in the U.S. good? Is it getting better or worse? How can we possibly find answers to these questions? Can the scientifically valid and clinically relevant performance measures significantly improve the quality and efficiency of patient care across the nation?
Health care itself is so complex and hence most of us do know what to expect when we need health care or whether we were treated appropriately or optimally. We need to be able to assess the performance of care that we receive. We need to have a system in place that promotes the best clinical standards and ensures the highest quality of patient care through transparency, accountability and credibility. But unfortunately, the nation has hundreds of quality measures that have been developed and no coordinated strategy for integrating and aggregating performance data. This has created an unnecessary burden for physicians and confusion among patients. Therefore there is no effective method for pinpointing gaps in quality and efficiency across the country.
What currently happens is that Quality is reported and perhaps monitored in a retrospective way on the Claims data. This data provide information such as admissions for specific conditions, treatment received, and readmission rates. These data are useful, but are limited to what is available: The Centers for Medicare and Medicaid Services publish reports using claims data, but it can be difficult to acquire representative information from private payers. This creates a huge gap in care. So how do we fill it? How do we really improve the quality in care?
Above and beyond monitoring the quality we need to come up with a solution that improves the quality. We need a solution that integrates the disparate data into a single source of truth. And we must move away from retrospective model to a more real-time mechanism with intuitive analytics, and not just absolute values. Using insights generated from such models we need to identify any gaps in care and work towards bridging the gaps. Maybe that is when we can actually improve the quality of US health care.
Accurately capturing data for submission to CMS is a prerequisite for getting reimbursements for providers, but this should not get limited to this. Through measure, reporting providers need to identify the areas where they lack in providing care and work towards improving such areas. Organizations need to engage with quality measures in a way that highlights improvement opportunities and provides the information necessary to drive change
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