This section briefly describes measures collected by the Centers for Medicare and Medicaid Services (CMS), as well as quality indicators for decision making and research developed by the Agency for Healthcare Research and Quality (AHRQ). These measures are used to monitor and evaluate a range of services to adjust payments based on the volume of preventable hospital and health care-acquired conditions, and to promote improvements in patient safety and care delivery.
Quality improvement in hospital settings is a key goal of the Deficit Reduction Act enacted on February 8, 2006. Section 5001(c) of this law requires the U.S. Secretary of Health and Human Services to identify conditions — commonly known as Hospital Acquired Conditions (HACs) — that meet any of the following criteria:
HACs are hospital-based quality measures that the Centers for Medicare and Medicaid Services monitor through the submission of clinical and claims data. CMS utilizes these metrics to determine the performance of hospitals in value-based programs and to encourage participating providers to improve care delivery by reducing the occurrence of preventable conditions.
For additional information visit CMS’ website.
Provider preventable condition (PPC) is an umbrella term for measures monitored by the Centers for Medicare and Medicaid Services (CMS) to ensure the quality of care and services provided to Medicaid beneficiaries. PPCs are subject to non-payment policies enforced by each state Medicaid agency; MassHealth in Massachusetts.
There are two categories of PPCs:
MassHealth utilizes clinical and claims data submitted by providers to determine which services meet a PPC definition and therefore are subject to the non-payment policy.
PSIs are one of four quality measurement areas that the Agency for Healthcare Research and Quality (AHRQ) has developed as part of a decision making and research tool kit called Quality Indicators (QIs).
Like HACs, these measures are culled from claims data; facilities do not directly report these indicators to federal or state agencies.
Unlike HACs, QIs are not solely focused on the support of structured value-based programs. Rather the tool kit offers research methods to analyze hospital inpatient administrative data so that users can highlight potential quality concerns, identify areas that need further study and investigation, and track changes over time. QIs are available free of cost to program managers, researchers, and other health officials at the federal, state and local levels.
For more information on PSIs, visit AHRQ.