The Affordable Care Act (ACA), or so-called Obamacare, is a federal act which was signed into law in 2010. Initially, it is aimed at providing Americans with “better health security by putting in place comprehensive health insurance reforms” (Medicaid.gov, n. d., par. 1). The latter ones are supposed to expand coverage, lower insurance, and healthcare costs, and improve the quality of care for the Americans.
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To begin with, the ACA contributed to the establishment of the Innovation Center (About the CMS Innovation Center, 2017). It allows testing new methods of payment and service delivery models that can potentially cut down expenses of Medicare, Medicaid, and Children’s Health Insurance Program (CHIP). At the same time, the goal is to preserve or even enhance the quality of patient’s care. Generally, the Innovation Center is focused on testing new payment models, evaluating their results, and engaging more stakeholders to the development of additional models for testing. Hence, the Affordable Care Act funds a massive innovational process, which cannot be underestimated.
While working on developing new payment and service delivery models, the Innovation Center follows the official requirements and consults clinicians and analytical experts. The selection of organizations that participate in testing a model is an open, transparent process, and attracts the most qualified partners. The results of testing are usually aimed at increasing the efficiency of health care payments and policies.
For instance, the Innovation Center is currently implementing the Quality Payment Program, which was created by Congress to replace Medicare’s way of payment for physicians’ and other medical services (About the CMS Innovation Center, 2017). This model is based on the principle that healthcare specialists get more focused on care quality, as the participation in the program gives them a performance-based payment adjustment. Thus, they become more motivated and determined to the best patient’s outcome.
The National Quality Forum offers a range of tools to measure and improve the quality of healthcare. Its measure search tool, QPS, suggests dividing measurements by type: the cost/resource use, efficiency, outcome, process, structure, and intermediate clinical outcome. Most of them have been endorsed. As for the Electronic Health Record (EHR), it was made to automate clinician’s workflow and give all information concerning the patient and his treatment process.
Therefore, all types of NQF measurements can be used in EHR, as they encompass the main purposes of the Electronic Health Record. “Once a measure is endorsed by NQF, it can be used by hospitals, healthcare systems, and government agencies like the Centers for Medicare & Medicaid Services for public reporting and quality improvement” (National Quality Forum, n. d., par. 4).
Quality health services are one of the major concerns for the Centers for Medicare and Medicaid Services (CMS). Hence, using quality measures is essential to assess the process of treatment and outcomes. The Affordable Care Act requires that CMS use nationally endorsed quality measures in the Hospice Quality Reporting Program. The data from Hospices is used to calculate seven NQF-endorsed measures, and these measures can be used in Electronic Health Record. In addition, CMS are currently providing services for the Medication Measures Special Innovation Project (Quality Measures, 2016). This project has eight NQF-endorsed measures for the ambulatory care setting. Thus, some of the NQF measures can be used in EHR to ensure quality metrics from an EHR endorsed by the CMS.
CMS.gov. (2017). About the CMS Innovation Center. Web.
CMS.gov. (2016). Quality measures. Web.
Medicaid.gov. (n. d.). Affordable Care Act. Web.
National Quality Forum. (n. d.). Measuring performance. Web.