Quality and Efficiency Measurement281
In selecting quality and efficiency measures to be used in the various provisions of the Social Security Act, and for public reporting of performance information, the Secretary must obtain input from a multi-stakeholder group.282 The Secretary must also include an assessment of the quality and efficiency impact of the use of endorsed measures283 that is made available to the public.284
The following providers must annually submit data on quality measures to the Secretary. Each provider will have an opportunity to review such data, which will then be made publicly available and reported on CMS’ website.
· Hospice programs,285
· Home health agencies,286
· Rehabilitation facilities,287
· Hospitals288 providing outpatient services,289
· Cancer hospitals,290
· Long-term care hospitals291,292
· Psychiatric hospitals and units.293
· Inpatient rehabilitation hospitals294
Every service provider must agree to release its patient data to a peer review organization in order for such organization to review the utilization and quality of health care services furnished by the provider.295 In addition to providing access to data, the following providers must maintain an agreement with a utilization and quality control peer review organization that has a contract with the Secretary under Title XI, Part B:
· Home health agencies,296
· Hospitals, including critical access hospitals,297 and
o With respect to inpatient services provided by a hospital, the organization will specifically review the validity of diagnostic information provided by the hospital, the completeness, adequacy and quality of care provided, and the appropriateness of admissions, discharges and the care provided.298
· HMOs.299
Footnotes
- 281. Social Security Act § 1890A, 42 U.S.C. 1395aaa-1.
- 282. Social Security Act § 1890A(a)(1), 42 U.S.C. 1395aaa-1(a)(1); For provisions using the quality and efficiency measure, see Social Security Act §1890(b)(7)(B), 42 U.S.C. 1395aaa(b)(7)(B).
- 283. Social Security Act § 1890A(a)(6)(A), 42 U.S.C. 1395aaa-1(a)(6)(A).
- 284. Social Security Act § 1890A(a)(6)(B), 42 U.S.C. 1395aaa-1(a)(6)(B).
- 285. Social Security Act § 1814(i)(5), 42 U.S.C. 1395f(i)(5) (requirement applies beginning in 2014).
- 286. Social Security Act § 1895(b)(3)(B)(v), 42 U.S.C. 1395fff(b)(3)(B)(v).
- 287. Social Security Act § 1886(i)(7), 42 U.S.C. 1395ww(i)(7) (requirement applies beginning in 2014).
- 288. Does not include psychiatric hospitals, rehabilitation hospitals, hospitals whose patients are predominantly under 18, long-term care hospitals (average length of stay over 25 days). Social Security Act § 1886(d)(1)(B), 42 U.S.C. 1395ww(d)(1)(B).
- 289. Social Security Act §1833(t)(17), 42 U.S.C. 1395l(t)(17).
- 290. Social Security Act § 1866(k), 42 U.S.C. 1395cc(k) (requirement applies beginning in 2014).
- 291. Social Security Act § 1886(m)(5), 42 U.S.C. 1395ww(m)(5).
- 292. Social Security Act § 1886(b)(3)(B)(viii)(VII), 42 U.S.C. 1395ww(b)(3)(B)(viii)(VII).
- 293. Social Security Act § 1886(s)(4), 42 U.S.C. 1395ww(s)(4) (requirement applies beginning in 2014).
- 294. Social Security Act § 1886(j)(7), 42 U.S.C. 1395ww(j)(7) (requirement applies beginning in 2014).
- 295. Social Security Act § 1866(a)(1)(E)(i), 42 U.S.C. 1395cc(a)(1)(E)(i).
- 296. Social Security Act § 1866(a)(1)(F)(ii), 42 U.S.C. 1395cc(a)(1)(F)(ii).
- 297. Social Security Act § 1866(a)(1)(F)(ii), 42 U.S.C. 1395cc(a)(1)(F)(ii).
- 298. Social Security Act § 1866(a)(1)(F)(i), 42 U.S.C. 1395cc(a)(1)(F)(i) (the organization will review).
- 299. Social Security Act § 1876(i)(7)(A), 42 U.S.C. 1395mm(i)(7)(A).
.png)