Eloquest Healthcare is excited to welcome back Jo Ann Brooks PhD, RN, FAAN, FCCP to the Eloquest Healthcare Blog! Dr. Jo Ann Brooks is a Healthcare Quality Consultant who retired in 2018 from Indiana University Health where she was System Vice President of Quality & Safety. In this role, she was responsible for oversight of quality and patient safety in a multi-hospital, integrated system as well as infection prevention across the state. Her areas of oversight included performance improvement, external quality reporting, patient safety, national databases, and ongoing development of the governance board’s role in quality and patient safety.

In her consulting role, she lectures and consults on healthcare quality and safety, CMS pay for performance, non-ventilator hospital-acquired pneumonia and sustainability in quality improvement. She currently serves as the Chair of IRB 04 for Indiana University. Her faculty appointments include IU Schools of Nursing and Medicine and Purdue University School of Nursing.

To say the least, 2020 was a challenging year for all of us and 2021 will continue to be difficult. When we get to “the end” of the pandemic and towards a more stable healthcare environment, healthcare will be forever changed. Healthcare quality has felt the impact of the pandemic in many ways—changes in focus and priorities, the need for rapid improvements, urgent data requests and submission just to name a few. These overwhelming and rapid changes have often overshadowed current healthcare quality news, which is the focus of this blog.

As background, it is well-recognized that over the past 20 years, our Department of Health and Human Services (HHS) Federal quality programs have lacked oversight, coordination and a governance structure. There has been poor alignment of common goals across settings, programs and inadequate information shared with the public and stakeholders to help guide quality improvement efforts. Furthermore, legislative acts and regulations have not been coordinated, which has led to a burdensome number of measures required for reporting. Although attempts have been made over the years to improve the federal health quality programs with differing initiatives and programs, this has been a slow process and only small improvements have been made. But there is hope for change…

On July 9, 2019, HHS announced the formation of the Quality Summit (QS) which was the first step in evaluating current quality programs under the directive of President Trump’s Executive Order 13877, Improving Price and Quality Transparency in American Healthcare to Put Patients First.¹ In its announcement, HHS noted that federal quality programs have not been reviewed externally since their inception. The first step of the QS was held at the end of 2019 and brought together key industry stakeholders and government leaders to discuss how current quality programs administered by HHS can be further evaluated, adapted, and streamlined to deliver better outcomes for patients.² Three one-day meetings were co-chaired by HHS Deputy Secretary Eric Hargan and Dr. Peter Pronovost, and 18 external (non-governmental) leaders from a variety of settings were chosen to participate and provide input about the effectiveness of existing healthcare quality programs.

Using the information gathered from the QS, HHS planned to use the first six months of 2020 to develop a National Health Quality Roadmap. The National Health Quality Roadmap was published by HHS on May 15, 2020.³ This is a well-written and detailed document that is worth reading for anyone interested in healthcare quality. The purpose of the Healthcare Quality Roadmap is to provide solutions to achieve the following six principles all of which are issues identified by the quality community.

And, there are three mechanisms identified in the Roadmap to achieve the principles and improve the Federal Quality Measurement Enterprise (see below figure):

The Roadmap provides specific and detailed action plans for each of the areas: governance and oversight, data collection/reporting/sharing and measure reform. Of note, one action in the measure reform section relates to the acute care setting and involves combining the Value-Based Purchasing Program, Readmissions Reduction Program and Hospital-Acquired Condition Program into one program. This was suggested previously by the Medicare Payment Advisory Committee (MEDPAC) in 2019.⁴’⁵

An aggressive timeline is included in the Roadmap for the majority of work to be launched by the end of 2020 (see Figure in document).³ Unfortunately, there are no updates on the HHS or CMS websites regarding any actions from the Roadmap moving forward during 2020. In 2021, the ongoing focus on the pandemic and the election of President Biden with changes in leadership for HHS and the Centers for Medicare and Medicaid Services (CMS) may further slow the work of the Roadmap. This is unfortunate as the document is exactly what is needed to improve CMS quality as well as the other programs under HHS. Implementation of the action plans in this document would move healthcare quality forward in an aligned and coordinated fashion to improve the care provided to our patients. Stay tuned—we can hope that healthcare quality improvements emerge from the shadow of the pandemic.

A few websites to check for potential updates are: HHS.gov, CMS.gov Newsroom, and CMS.gov Quality Measures.

1. https://www.federalregister.gov/documents/2019/06/27/2019-13945/improving-price-and-quality-transparency-in-american-healthcare-to-put-patients-first
2. https://public3.pagefreezer.com/browse/HHS.gov/31-12-2020T08:51/https://www.hhs.gov/about/news/2019/07/09/hhs-quality-summit-fact-sheet.html
3. https://www.hhs.gov/sites/default/files/national-health-quality-roadmap.pdf
4. King, R. (2019). MedPAC recommends consolidating Medicare quality programs. Modern Healthcare 49(3): 13.
5. MEDPAC. Report to Congress, Medicare and the Health Care Delivery System, June 2018; MEDPAC meeting, January 17-18, 2019. http://www.medpac.gov/-public-meetings-/meeting-details/january-2019-public-meeting