Quality 101

How do physicians know if the care/services they provide really impacts patient health? How do patients identify physicians who provide excellent care and can help them get better? And how do payers and employers determine whether they are getting good value for their health-care dollars? Performance measures are a method of assessing how a provider’s health-care actions compare against recognized evidence based guidelines or standards of care.

What is Quality?
Why Measure?
What are the Right Measures?
How Measures Will Serve Our Future
Reading Resources

What is Quality?

The science of measuring health-care performance has made enormous progress over the last decade, and it continues to evolve. Measures represent a critical component in the national endeavor to assure all patients of appropriate and high-quality care.

Listen to a podcast discussion between two GI thought leaders who are involved in quality initiatives in their areas. Joel V. Brill, MD, AGAF, FASGE, FACG, CHCQM, chief medical officer, Predictive Health, LLC, and Stephen W. Hiltz, MD, MBA, AGAF, FACG, Tri-State Gastroenterology Associates, discuss quality and what you need to know to help manage your practices wisely. Listen now.

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Why Measure?

There are several types of measures, each with different purposes, that illuminate various aspects of care, thereby showing where systems are breaking down and where they are succeeding to help patients get and stay well.

  • Measures drive improvement. Teams of health-care providers who review their performance measures are able to make adjustments in care, share successes and probe for causes when progress comes up short — all on the road to improved patient outcomes.
  • Measures inform consumers. As a growing number of measures are publicly reported, consumers are better able to assess quality for themselves, and then use the results to make choices, ask questions and advocate for good health care. Some providers now post performance measures on their web sites, and sometime this year, consumers will be able to consult a Physician Compare web site from Medicare.
  • Measures influence payment. Increasingly, private and public payors use measures as preconditions for payment and targets for bonuses, whether it is paying providers for performance or instituting nonpayment for complications.

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What are the Right Measures?

Different measures prove useful for different purposes, depending on their focus. Some measures assess compliance with specific steps in providing care, such as whether heart attack patients receive prescriptions for beta blockers and anti-lipid medications at discharge. Other measures use a wide-angle lens to look at results — for example, whether patients sent home from the hospital have improved health or end up coming back with complications that could have been avoided. Each tool provides a different view — assessing performance from a specific angle. In using measures it is important to keep in mind what they are measuring and from which angle. This understanding will also help you as you analysis measure results and work to implement any necessary changes. 

  • Process measures show whether steps proven to benefit patients are followed correctly. They measure whether an action was completed, such as writing a prescription, administering a drug or having a conversation.  
  • Patient experience measures record patients’ perspectives on their care such as in patient satisfaction surveys.
  • Structural measures reflect the conditions in which providers care for patients. These measures can provide valuable information about staffing and the volume of procedures performed by a provider.
  • Composite measures combine the result of multiple performance measures to provide a more comprehensive picture of quality care.
  • Outcomes measures take stock not of the processes, but of the actual results of care. They are generally the most relevant measures for patients and the measures that providers most want to change.

Registries, such as the AGA Digestive Health Outcomes Registry®, are powerful quality improvement tools that will provide feedback to practices about the care they provide. The feedback, at the provider and practice level, will allow you to benchmark care against aggregate data of other gastroenterologists providing care to similar patients. At the patient level, the data can help practices monitor patient care, track interventions and outcomes.

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How Measures Will Serve Our Future

Measures are becoming both more precise and more complex. The next generation of measures will span health-care settings and episodes of care to present a more complete picture of care. In the public arena, reporting of measures will become clearer and easier for patients and their families to understand and use. Without good data, health-care systems simply cannot accurately measure and assess performance.

Under the Patient Protection and Affordable Care Act (PPACA), the Physician Quality Reporting System (PQRS) offers incentive payments for successful quality reporting to 1 percent in 2011 and .5 percent in 2012 through 2014. Beginning in 2015, however, physicians who do not report on quality measures to the PQRS will receive a 1.5 percent cut in Medicare reimbursement and a 2 percent cut in payments in 2016 and thereafter. The PPACA requires CMS to create an appeals process for physicians and to provide timely feedback for participating physicians, two positive changes to the program for which the AGA and the Alliance of Specialty Medicine advocated.

Continue to read AGA eDigest as the AGA Think Tank on the Future of Practice will continue to provide information about quality measures, the entities involved in creating and approving measures, and how quality can maximize your reimbursement.

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Reading Resources

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Updated March 8, 2011