Quality measurement: It's here to stay.

Area of Science:

• Health Services Research
• Healthcare Quality Improvement
• Health Economics

Background:

• The Centers for Medicare and Medicaid Services (CMS) is undergoing a significant shift from volume-based to value-based healthcare reimbursement.
• Measuring the value of healthcare necessitates robust methods for assessing both quality and cost.

Purpose of the Study:

• To provide an overview of healthcare quality measurement strategies.
• To review the widely-used structure, process, and outcome (SPO) conceptual model for quality assessment.
• To describe prominent CMS programs through the lens of the SPO model.

Main Methods:

• Literature review of quality measurement concepts.
• Analysis of the structure, process, and outcome (SPO) model for healthcare quality.
• Description of key CMS initiatives including Physician Quality Reporting System, Physician Compare, and Medicare Shared Savings Plan.

Main Results:

• The SPO model offers a framework for understanding healthcare quality measurement.
• CMS programs increasingly incorporate outcome measures alongside process measures.
• Public reporting of quality metrics is a growing trend.

Conclusions:

• The SPO framework is valuable for evaluating healthcare quality and CMS programs.
• The shift towards outcome measures and public reporting signifies a move towards greater accountability in healthcare.
• Understanding these quality measurement approaches is crucial for healthcare providers and policymakers.