Reference no: EM132924095

Measures of Quality

Quality health care is a high priority for the President, the Department of Health and Human Services (HHS), and the Centers for Medicare & Medicaid Services (CMS) (Centers for Medicare & Medicaid Services, 2021). CMS implements quality initiatives to assure quality health care for Medicare Beneficiaries through accountability and public disclosure (CMS, 2021). CMS uses quality measures in its various quality initiatives that include quality improvement, pay for reporting, and public reporting (CMS, 2021). Quality measures are tools that help us measure or quantify health care processes, outcomes, patient perceptions, and organizational structure and/or systems that are associated with the ability to provide high-quality health care and/or that relate to one or more quality goals for health care (CMS, 2021). These goals include: effective, safe, efficient, patient-centered, equitable, and timely care and CMS uses quality measures in its quality improvement, public reporting, and pay-for-reporting programs for specific health care providers (CMS, 2021). Data on quality measures are collected or reported in a variety of ways, such as claims, assessment instruments, chart abstraction, registries (CMS, 2021).

Patient Falls

A basic principle of quality measurement is: if you cannot measure it, you cannot improve it (Johnson & Magnan, 2019). Therefore, fall rates and fall prevention practices must be counted and tracked as one component of a quality improvement program. By tracking performance, then care improvement will show, staying the same, or worsening in response to efforts to change practice and continued monitoring will help understand where the starting point is from and whether improvement gains are being sustained (Johnson & Magnan, 2019). Fall and fall-related injury rates are the most direct measure of success in making patients safer related to falls. If rates are improving, then you are likely doing a good job in preventing falls and fall-related injuries (Johnson & Magnan, 2019). Conversely, if the fall and fall-related injury rates are getting worse, then there might be areas in which care can be improved znd you can use these data to make a case for initiating a quality improvement effort and monitoring progress to sustain your improvements (Johnson & Magnan, 2019).

The Hospital-Acquired Condition (HAC) Reduction Program is a Medicare pay-for-performance program that supports the CMS effort to link Medicare payments to health care quality in the inpatient hospital setting to encourage eligible hospitals to reduce HACs (Johnson & Magnan, 2019). Section 1886(p) of the Social Security Act established the statutory requirements for the HAC Reduction Program. The HAC Reduction Program is a Medicare value-based purchasing program that reduces payments to hospital based on how they perform on measures of hospital-acquired conditions (CMS, 2021). The program supports CMS's long-standing effort to link Medicare payments to health care quality in the inpatient hospital setting (CMS, 2021). This measure affects my organization from the falls with hip fracture issue and also readmissions for fall related injury readmissions (Singh et al., 2019).

Question 1: How Do These Standards and Regulations Influence or Support Ethical Principles, and Influence Patient Care and Nursing Practice?

CMS's new comprehensive initiative "Meaningful Measures" was launched in 2017 and identifies high priority areas for quality measurement and improvement. Its purpose is to improve outcomes for patients, their families and providers while also reducing burden on clinicians and providers (Hickey, & Giardino, 2019). Although the original Meaningful Measures initiative accomplished its initial goals, its scope and purpose have evolved to keep pace with a rapidly changing health care environment (Hickey, & Giardino, 2019). With Meaningful Measures 2.0, CMS will not only continue to reduce the number of measures in its programs but will further shape the entire ecosystem of quality measures that drive value-based care (Hickey, & Giardino, 2019). Meaningful Measures 2.0 will promote innovation and modernization of all aspects of quality, addressing a wide variety of settings, stakeholders, and measurement requirements (Hickey, & Giardino, 2019). Commit to a patient centered approach in quality measure and value-based incentives programs to ensure that quality and safety measures address health care equity is an objective of Meaningful Measures 2.0 (Hickey, & Giardino, 2019).