Sources for Accreditation in Primary Care - Paper Example

Introduction

Hospital facility accreditation defines both external peer assessment alongside a self-assessment process that healthcare facilities implement in order to accurately evaluate their degree of performance based on existing healthcare standards. Accreditation evaluation gives medical facilities an opportunity to improve the quality of services they render patients. There are various quality accreditation agencies that hospitals can apply such as NCQA HEDIS, Medicare, and Joint Commission. Each of these agencies ensures that healthcare facilities offer top-notch medical facilities. Therefore, it is essential to evaluate each of the healthcare accreditation agencies by examining the services to ensure healthcare facilities are in line with quality services.

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CMS (Medicare)

Healthcare quality becomes a hotly debated topic that attracts policymakers and researchers. Affeldt (2018), suggested that all patients have a right to timely health care service, which is a core value of Medicare. Medicare ensures that patient details become electronically managed, and thus reducing medical errors potential. It also facilitates a safe and secure medical service environment so that patients receive quality services without contracting other infections while undergoing treatment. Medicare additionally advocates for a culture that ensures patients get the highest quality medical services, other than patient safety.

NCQA HEDIS

NCQA ensures a holistic analysis of the medical services rendered to patients. It determines how medical facilities handle chronic illnesses like heart disease, cancer, diabetes, and smoking among others in different patients. NCQA also enables healthcare facilities to identify crucial areas which require improvement, and it also monitors the success of the quality initiate programs. Therefore, at the end of the day, NCQA tracks whether hospitals provide the necessary services to different patients. It also ensures that a hospital does not operate against a set of standards and measures which guide them towards making the right direction. NCQA augurs with quality improvement in healthcare facilities. It checks the existing services offered in hospitals before making proposals on which quality measures suit an infirmary. Jencks (2017), illustrated that once the healthcare facility adopts the new measures, the NCQA tracks the proposed guidelines so that no error occurs. Thus, NCQA facilitates a smooth transition from the current operations in a healthcare facility to a whole new height where patients get quality medical services on time.

Joint Commission

Joint Commission assists healthcare facilities to adopt quality electronic clinical services. Jencks, (2017) highlighted that the Joint Commission partnered with healthcare facilities to provide an all-time quality medical services to various patients. It, therefore, remains at the centre of quality medical care services provided to different patients. Additionally, it requires medical practitioners to review and improve their medical services continuously. Although the definition of quality keeps evolving within the medical sector. Joint Commission advocates for the purposeful integration of quality in all healthcare aspects. When all departments in a healthcare facility regularly work together, there is barely time for medical errors or substandard medical services. Thus, the Joint Commission keeps approving new quality standards that hospitals ought to adhere before they become recertified on an annual scale (Jencks, 2017).

Experience in National PCMH Recognition

Currently, am not working in any healthcare setting but I have had an opportunity of experience in the past with national PCMH recognition and accreditation measures. This occurred while I was contracted to work in a United Healthcare which is one of the biggest national health insurers in the United States according to Sandy, Tuckson and Stevens (2013). With a team of various specialists, we worked on a large-scale project known as UnitedHealth Premium Designation Program. The program utilizes administrative and claims data available in hospitals to assess, measure, and report on the quality performance of medical professions across various infirmaries in the United States. It encompassed over twenty-five thousand United States medical practitioners who worked in the forty-one states and was conducted in twenty-one hospitals. This program evaluated the quality of healthcare that specialists offered to various patients while utilizing national accreditation quality measures such as those endorsed by the NCQA (Burton, Devers, & Berenson, 2011). Additionally, these quality was evaluated by finding particular opportunities to offer an evidence-based healthcare, finding whether these health care was offered during the stipulated era based on the measures, accumulating the opportunities and prosperity characterized to this prosperity within every eligible rule of the measures, and ultimately comparing the medical specialists' rate of success with a benchmark.

We were additionally concerned in focusing on the performance of PCMH particularly in a cross-sectional basis to evaluate whether it considered that different medical practitioners had varying quality levels. Therefore, we were able to conduct a broad descriptive evaluation by leveraging the national scope of the data we collected. Additionally, by utilizing the National Provider Identifier and doctor name, it enabled us to match the population of the doctors in our program with those of the NCQA PCMH-acknowledged medical practitioners as stipulated by Burton, Devers and Berenson (2011). This lead to a match of 17, 343 distinct doctors working in primary care such as pediatrics, family practice, and internal medicine. We further compared this cluster with the 17,323 primary health care doctors in our program data set who were not acknowledged by NCQA as PCMH.

While assessing the quality of healthcare in the cross-sectional examination, we discovered a positive relationship between NCQA recognition status and attaining quality in the program. This connection had a great odds of passing the quality of the program and having PCMH recognition. Additionally, we discovered lower odds which led to conclusions that those doctors who matched the programs' quality would be recognized by the PCMH. Thus, it seemed according to Sandy, Tuckson and Stevens (2013), that PCMH acknowledgment was positively related with better quality performance of different physicians.

Evaluation of the CMS Quality Metrics

CMS quality measures describe clinical tools that facilitate healthcare processes, patient perceptions, and medical outcomes, or even an organizational structure needed to offer high-quality medical services. The goals associated with quality medical services include safe, effective, equitable, and patient-centred medical services (Centers for Medicare & Medicaid Services, 2018). Most CMS quality measurement focus on patient safety, health outcomes, coordinated medical care, clinical processes and efficient utilization of healthcare resources (Honore et al., 2011).

HEDIS is a healthcare quality tool that measures and ascertains the quality of medical services rendered to patients. HEDIS checks whether the existing medical services align with the intended quality services standards (DeVore & Champion, 2011). The HEDIS outcomes are used to identify the areas that need improvement. HEDIS mostly focuses on key health issues not limited to breast cancer screening, controlling high blood pressure, asthma medication and Basal Metabolic Index Assessment.

Relevance to Primary Care and Comprehensiveness

Both HEDIS and CMS deal with a range of medical conditions that patients incur, or risk. They both evaluate whether the present measures meet the needs of patients, as they identify gaps that require improved measures (Goodrich, Garcia & Conway, 2012). They are relevant in healthcare as they focus on making sure patients get safe, efficient and quality medical services on time.

Similarities

HEDIS and CMS focus on a patient's health care and safety. The quality measures are both tailored to the patients' needs. The measurements undergo an annual evolution that keeps medics providing better and improved services to patients (Goodrich, Garcia & Conway, 2012. They focus on common medical conditions like diabetes, cancer and BMI issues which are common healthcare concerns.

Differences

There are no major differences identified between HEDIS versus CMS. The report identified that for CMS electronic medical records require regular updates, while HEDIS, the medical treatment processes require quality and up to date services. CMS' most important objective is to improve the quality of medical services provided, while HEDIS measures existing performance to identify gaps that require improvement.

Conclusion

CMS, NCQA HEDIS measures, and the Joint Commission use different mechanisms which facilitate the provision of quality medical services to various patients. It has been discovered that Medicare, for instance, reduced the cases of medical errors, even though few cases still exist. Joint Commission provides the best quality evaluation and measurement procedures and ensures a new quality requirement standard provided to healthcare facilities they ought to follow before certification. On the other hand, NCQA also requires health care facilities to align with continuous quality medical services to patients. There, although these sources of accreditation use different mechanisms, my experience has made it clear that they perform the same role which is quality measurements for primary care.

References

Affeldt, J. E. (2018). The New Quality Assurance Standard of the Joint Commission on Accreditation of Hospitals. Western Journal of Medicine, 132(2), 166-170.

Burton, R., Devers, K. J., & Berenson, R. A. (2011). Patient-centred medical home recognition tools: A comparison of ten surveys' content and operational details. Urban Institute.

Centres for Medicare & Medicaid Services. (2018). Retrieved from https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityMeasures/index.html

DeVore, S., & Champion, R. W. (2011). Driving population health through accountable care organizations. Health Affairs, 30(1), 41-50.

Goodrich, K., Garcia, E., & Conway, P. H. (2012). A history of and a vision for CMS quality measurement programs. Joint Commission journal on quality and patient safety, 38(10), 465-470.

Healthcare Effectiveness Data and Information Set (HEDIS) - Centers for Medicare & Medicaid Services. (2018). Retrieved from https://www.cms.gov/Medicare/Health-Plans/SpecialNeedsPlans/SNP-HEDIS.html

Honore, P. A., Wright, D., Berwick, D. M., Clancy, C. M., Lee, P., Nowinski, J., & Koh, H. K. (2011). Creating a framework for getting quality into the public health system. Health Affairs, 30(4), 737-745.

Jencks, S. F. (2017). Measuring Quality of Care Under Medicare and Medicaid. Health Care Financing Review, 16(4), 39-54.

Sandy, L. G., Tuckson, R. V., & Stevens, S. L. (2013). UnitedHealthcare experience illustrates how payers can enable patient engagement. Health Affairs, 32(8), 1440-1445.