Take the Necessary Steps toward Value-Based Care

Take the Necessary Steps toward Value-Based Care

As part of Medicare’s efforts to improve the quality and efficiency of medical care, the Physician Feedback/Value-Based Payment Modifier Program provides comparative performance information to physicians and medical practice groups. By providing meaningful and actionable information for doctors to apply towards quality improvement, CMS is shifting towards a model of physician reimbursement that rewards value rather than volume. Using workflow analysis and other proven methods, QIN-QIOs will help providers identify and close gaps in care coordination, improve efficiency and quality, and meet or exceed national reporting requirements.

Quality Innovation Network (QIN)-QIOs work with a variety of providers and care facilities to navigate quality reporting, the Physician Feedback/Value-Based Payment Modifier Program, and Quality and Resource Use Reports (QRURs).  Providers and facilities include:

• Eligible physicians and physician groups
• Inpatient and outpatient hospital departments
• Acute care and critical access hospitals
• Inpatient Psychiatric Facilities (IPFs)
• PPS-exempt Cancer Hospitals (PCHs)
• Ambulatory Surgical Centers (ASCs)

Quality Matters

As a health care provider, you’ve always done your best for patients. So why is it that hundreds of thousands of Americans die every year from medication errors, infections they acquired during a hospital stay, or other preventable consequences of seeking care?

It’s not because health care professionals are unskilled or uncaring. It’s because processes for delivering care have broken down, triggering adverse events and poor patient outcomes. Quality matters because lives are at stake. We are fully capable of doing better once processes associated with positive outcomes are in place.

Additionally, Quality matters because the economic landscape of health care is changing rapidly. Medicare has begun to pay dialysis centers and hospitals on the basis of quality, not solely volume. It has expanded its value-based purchasing programs into other care settings, including physician practices and ambulatory surgery centers. The providers most likely to succeed in the health care system of the future are those who can demonstrate clinical quality.

Let’s Improve Healthcare systems by:

Improving the Health Status of Communities

Promote Effective Prevention and Treatment of Chronic Disease by:

• Provide more effective treatment to patients at risk for heart attack and stroke, especially those in underserved populations
• Reduce disparities in diabetes care by supporting self-management education in disadvantaged communities
• Use the electronic health records to their full potential, and to make sure patients receive preventive services

Promoting Safe Care that is Patient and Family-Centered, Reliable and Accessible

Reducing avoidable admissions and readmissions by improving the quality of care transitions. Their efforts resulted in approximately $1 billion in costs savings between 2011 and 2014, indicating an increase in the number days beneficiaries remain in their home.

Medication safety in all healthcare settings is essential to care coordination and the health of Medicare beneficiaries. Adverse drug events (ADEs) are a leading cause of preventable patient harm.  Poorly coordinated care can be a significant contributor to ADEs, particularly when multiple providers prescribe medications that could conflict and complicate the patient’s condition. ADEs cause unnecessary stress on the patient and the healthcare system and may contribute to:

• Unnecessary diagnostic tests
•   Avoidable hospital admissions/readmissions
•   Preventable doctor’s office or ER visits
•   Unneeded treatment
•   Lost patient productivity
•   Patient death

Make Care Safer and Reduce Harm Caused in the Delivery of Care by:

• Working across the continuum of care to prevent healthcare-associated infections in hospitals and other care settings; providing assistance in spreading and sustaining evidence-based practices for infection prevention and reduction
• Targeting prevention of healthcare-acquired conditions in nursing homes, and in all patient safety efforts, facilitating collaboration, innovation, and enhanced patient and family engagement

Promote Effective Communication and Coordination of Care by:

• Helping community stakeholders, providers, patients, and families to organize for better coordination of care transitions, improved discharge communication, better access to community services and to share evidence-based approaches to reduce avoidable hospital readmissions, especially in vulnerable populations affected by poor care coordination
• Working with providers and stakeholders across care settings to reduce potential adverse drug reactions, medication errors, overdoses, allergic reactions and other adverse drug events; promoting medication management strategies, especially for high-risk medications like anticoagulants, opioids, and diabetic agents

NOTE:

Between 2011 and 2014, QIO Program efforts to improve care transitions helped avoid approximately 44,640 potential ADEs.

Extracted from CMS QIO Program