I don’t care what people say…Quality is here to stay!

As usual I have a song in my head and this month is no different (rock ‘n’ roll tunes are so catchy)!  As we are about to navigate through uncertain waters in the healthcare world, much discussion and debate has focused on repealing/replacing/keeping the Affordable Care Act.  And I will not be voicing an opinion on that!  But I do have a few thoughts to share with you.

First, the wheels of change in government have never been swift.  So, how will this climate be any different?  Changes are needed in the quality reporting programs, but there is not enough meaningful data (and stable data without major changes to the code sets and metrics!) to evaluate and enact changes….yet.

Secondly, quality and quality reporting aren’t really that new and did not suddenly appear with the Affordable Care Act.  As a reminder, real meaningful quality improvement efforts and reporting actually started back in the late 90s with the landmark report released by the Institute of Medicine: To Err is Human.  This paved the way for meaningful legislation, development of best practice standards of care, and measurable outcomes.  The Deficit Reduction Act of 2005 saw the genesis of the Hospital Acquired Conditions program which was meant to be a deficit reduction measure (and still is) and resulted in decreased payment for selected complications not present on admission. 

What is unique about the Affordable Care Act is the transparency of quality outcomes, and payment for services tied to quality of care/outcomes instead of volume or total charges.  As a reminder, two of the quality programs—the Hospital Acquired Condition Reduction Program (HACRP) and Value-Based Purchasing (VBP)—are budget neutral programs.  In other words, the government does not reduce Medicare spending through these programs.  Granted, the Hospital Readmissions Reduction Program (HRRP) and Merit Based Incentive Program (MIPS) can result in a decrease in total reimbursement from CMS for care given.  And as these two are currently the most likely to change, they are also the most controversial and challenging. They did not have their origin in the Affordable Healthcare Act legislation, however.

So with new leadership at the highest levels of government (including Health and Human Services), can we expect changes to quality programs (or elimination of them)?  It is certainly too early to say.  But even as the debate/discussion/legislation begins, the healthcare community is still in the thick of it and is required to report quality metrics at this time.  I would discourage any organization from taking their foot off of the quality improvement gas pedal thinking that change will come so quickly that our current efforts will not be needed.  As an old adage says “don’t count your chickens until they are hatched.”

But I have a more altruistic reason for telling everyone to proceed forward with their efforts:  It’s the right thing to do!  Surely, most of us got into the healthcare industry because we wanted to help people, not harm them, right?  Shouldn’t we always be striving to do better for our patients? To provide them the best of care with the least amount of morbidity and mortality?  We need to continue to strive toward “clean” data through education, clarification and second level reviews.  Only after we have completed those efforts can we realistically assess the quality of our care, investigate trends and implement evidenced based care to do better for our patients.

Quality should be here to stay!  Happy Holidays!

Cheryl Manchenton is a senior inpatient consultant and project manager for 3M Health Information Systems.