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Quality Measurement and Reporting in Massachusetts

The state of Massachusetts has introduced a number of measures to measure and track health care quality.  One example is the Health Care Quality and Cost Council.  The purpose of the Council is to improve health care quality, reduce racial and ethnic disparities, and contain costs.  The Council achieves this by giving consumers, providers, and insurers health care quality and cost information, establishing quality improvement goals, establishing standard performance measures, quality benchmarks, and encouraging statewide health information technology adoption.  The law requires the Council to annually publish standard performance measures, report on quality measures, pay for performance reimbursement, quality benchmarks on providers, and goals on the adoption of health information technology.1

Massachusetts law requires the Department of Community Health to assess the quality of care delivered to Medicare patients by hospitals.  Hospitals are required to submit data to the Department to conduct the evaluation.2  The state has taken additional steps to monitor and evaluate the quality of health care provided to its Medicaid population by requiring rate increases for Medicaid participating hospitals to be based on adherence to quality standards and benchmarks, including the reduction of ethnic and racial disparities in health care.3  Similar requirements are imposed on personal health care attendants in order to assess the health, welfare and satisfaction of consumers of in home care.4

Massachusetts also has disease or condition specific quality initiatives.  The law requires each cardiac catheterization center to maintain a quality assessment and performance improvement (QAPI) system that focuses on patient outcomes and also looks at overall laboratory safety and efficiency.  The QAPI program must identify indicators of quality based on national standards, collect and maintain data, compare the data to nationally accepted quality benchmarks, and prepare reports comparing results and plan ways to improve quality.5  Similarly, hospitals must collect and analyze data on patients with acute strokes, and identify ways to improve quality.6   The law requires hospitals to submit this data to the Department of Public Health.7  Massachusetts requires similar reporting on patient outcomes data for cardiac surgeries and angioplasties.8

 

Footnotes

  • 1. M.G.L.A. 6A §16K
  • 2. M.G.L.A. 111 §51D
  • 3. M.G.L.A. 118E §13B
  • 4. M.G.L.A. 118G §33
  • 5. 105 MA ADC 130.965
  • 6. 105 MA ADC 130.1410
  • 7. 105 MA ADC 130.1410
  • 8. 105 MA ADC 130.1203; 105 MA ADC 130.1302

 

Quality Measurement and Reporting in Massachusetts

Subtopic Statute/Regulation Description
Quality assurance programs for hospitals or public programs 105. Mass. Code Regs. 130.1103. - Interpreter Service - Coordinator “Interpreter Service – Coordinator”   Each acute hospital in connection with its emergency department service shall designate...
105 Mass. Code Regs. 130.1302. - Angioplasty Patient Outcome Monitoring Requirements All hospitals that provide angioplasties must provide patient specific surgery outcome data to the Data Analysis Center (a center contracted out by...
105. Mass. Code Regs. 130.833. - Quality Assurance “Quality Assurance”   Satellite Emergency Facility (SEF)specific quality assurance screens shall be developed. These screens must...
105. Mass. Code Regs. 130.965. - In-house Evaluation of Quality Each cardiac catheterization center must maintain a quality assessment and performance improvement (QAPI) system that focuses on patient outcomes and...
105. Mass. Code Regs. 140.613. - Evaluation of Quality “Evaluation of Quality”   The quality assurance program established by each clinic licensed to perform surgery must also include...
105. Mass. Code Regs. 143.015. - Evaluation of Quality “Evaluation of Quality”   Each program must establish an organized, comprehensive quality assurance program that is adequate to...
105. Mass. Code Regs. 144.016. - Quality Evaluation and Assurance Program “Quality Evaluation and Assurance Program”   The clinic administration must develop and maintain an ongoing quality evaluation and...
Performance measurement for health care providers or insurance plans 105. Mass. Code Regs. 130.1203. - Cardiac Surgery Patient Outcome Data Requirements All hospitals that provide cardiac surgeries must provide patient specific data to the Data Analysis Center (a center contracted out by the...
105. Mass. Code Regs. 130.1303. - Angioplasty Patient Outcome Data Requirements All hospitals that provide angioplasties must provide patient specific data to the Data Analysis Center (a center contracted out by the Department of...
Quality reporting requirements – providers and health plans 105. Mass. Code Regs. 130.1410. - Quality Improvement Hospitals must implement a data driven quality assessment and performance improvement program for the Primary Stroke Service.  The hospital must...
105. Mass. Code Regs. 130.348. - Monitoring Quality of Service “Monitoring Quality of Service”   The discharge planning servicemust develop and implement a system to monitor the quality of the...
105. Mass. Code Regs. 130.820. - Definitions “Definitions”   This section defines “Satellite Emergency Facility” (SEF) and “Emergency Department.”...
958. Mass. Code Regs. 3.600. - Reporting Requirements “Reporting Requirements”   Carriers must provide the information set forth in this section to the Office of Patient Protection each...
Mass. Gen. Laws. Ann. ch. 111C, §11 - Statewide coordinated trauma care system; regulations and guidelines “Statewide coordinated trauma care system; regulations and guidelines; trauma registry reporting and analysis system; designation as trauma...
Quality assessment for health plans 105. Mass. Code Regs. 130.965. - In-house Evaluation of Quality Each cardiac catheterization center must maintain a quality assessment and performance improvement (QAPI) system that focuses on patient outcomes and...
Use and availability of Patient satisfaction surveys/Facility compliance surveys 105. Mass. Code Regs. 130.965. - In-house Evaluation of Quality Each cardiac catheterization center must maintain a quality assessment and performance improvement (QAPI) system that focuses on patient outcomes and...
Quality Measurement and Reporting Mass. Gen. Laws. Ann. ch. 111, § 51D - Discrimination by acute hospitals against Medicare beneficiaries; Discharge planning An acute hospital cannot establish discriminatory practices in relation to admission, availability of services or treatment or transfer for any...
Mass. Gen. Laws. Ann. ch. 118E, § 13B - Hospital rate increases; Quality standards and benchmarks Rate increases for Medicaid participating hospitals must be based on adherence to quality standards and benchmarks, including the reduction of ethnic...
Mass. Gen. Laws. Ann. ch. 12C, § 16 - Annual report based on information submitted under Secs. 8, 9, and 10; hearing Annual report based on information submitted under Secs. 8, 9, and 10; hearing The Center for Health Information and Analysis must publish an annual...
External review for insurance and/or peer review purposes (Cross reference to Private Insurance Data and Medical Peer Review) Mass. Gen. Laws. Ann. ch. 111, §205 - Information and records necessary to comply with risk management and quality assurance programs “Information and records necessary to comply with risk management and quality assurance programs; confidentiality; definitions”  ...
Reporting, Use and/or Confidentiality of quality data (Cross reference Privacy & Confidentiality) Mass. Gen. Laws. Ann. ch. 111, §205 - Information and records necessary to comply with risk management and quality assurance programs “Information and records necessary to comply with risk management and quality assurance programs; confidentiality; definitions”  ...