Compliance with Core Measures
Core measures are evidence-based practices that were introduced to enhance better delivery of medical services and promote the management of patients. The Center for Medicare and Medicaid Services (CMS), in conjunction with The Joint Commission (TJC), analyzed agreed practices and formulated various set processes that are used to address different conditions (Bulloch, Tapley, Sivaraman, & Parton, 2016). Notably, this strategy encourages medical professionals to follow a standardized approach when dealing with patients. The organization I work for has a 90% compliance rate to the core measures established when dealing with pneumonia.
The pneumonia guidelines provide that medical staff should promote the cessation of smoking for people with this condition. Additionally, antibiotics should be administered within four hours of a patient’s admission (Mecham, Vines, & Dean, 2017).
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Health professionals should also assess arterial oxygenation within 24 hours of admitting a person with a pneumonia diagnosis. Moreover, practitioners must draw blood cultures of individuals admitted via the emergency section before administering antibiotics (Gonzalez et al., 2015). Documentation of the above measures is also recommended. The following table shows the firm’s statistics in the past month.
Indicator Statistics
Percentage of pneumonia patients who were advised to stop smoking 94%
Blood cultures drawn for patients admitted in the emergency part 90%
Percentage of individuals who received antibiotics within four hours 91%
Arterial oxygenation cases 88%
Although following the guidelines strictly is difficult, medical staff at the facility I work for have made significant steps. The hospital prioritizes the identification and management of pneumonia patients. Notably, this condition is hard to recognize immediately a person arrives at the institution. Thus, all new admissions must be reviewed for pneumonia. The health center tries to provide special care to all people who are diagnosed with this ailment. Another important strategy that the facility employs is having a concurrent reviewer who monitors the care provided to the target group. The individual reviews patients’ charts to ascertain that the core measures have been followed. While doing so, the professional might also help to identify gaps in patients’ treatment schedule and alert the appropriate medical personnel for action to be taken. In short, the reviewer is key to ensuring that the hospital is on course by acting as a link between the sick and the health practitioners. For instance, while conducting the usual routines, the individual might encounter ailing people who are likely to miss a dose of antibiotic. In such a case, the reviewer can alert a nurse or a physician to give the medication or ensure that the sick are updated on their medication schedule.
The organization also has a quality improvement team that tracks and analyzes the hospital’s adherence to the core measures. The group comprises of nurses, pharmacists, and anesthesiologists who conduct biweekly meetings to review data on compliance. The failures and their causes are discussed in detail to identify corrective measures. In most cases, the fallouts that emerge relate to omission and documentation errors. Once noted, the manager discusses with the staff members responsible to avoid a repeat of a similar situation.
The organization has a higher compliance rate compared to other facilities around the area. Most of the health centers around the region range from 80-88%. The inclusion of a quality team and an independent reviewer has been instrumental in promoting our institution’s compliance. These strategies increase the chances of conforming to the core measures.
Policy, Regulatory, and Financial Implications of Core Measure Reporting
Core measures are essential in promoting the provision of quality services. The CMS and TJC require health facilities to report their compliance levels to inform policy interventions. Notably, the two bodies use the data presented to understand the progress in the medical field. For instance, the system helps policymakers to understand what is working and what is not. Thus, new measures can be introduced to enhance the delivery of service further. Additionally, this reporting is important for organizations as they can understand their weaknesses and strengths. Therefore, it informs in-house decisions made by the facilities. However, organizations cannot face any regulatory implications by not complying with the set standards.
The failure to adhere to the core measures can have financial implications for an organization. Notably, the pay for performance initiative has increased the need to collect quality measures. Reimbursement to healthcare organizations is highly being tied to the scores that institutions score. Therefore, reporting and the delivery of quality services, as envisioned in the core measures, is key. Additionally, patients can a health center’s performance by visiting the CMS’s website. Moreover, individuals can compare each organization’s score. Health facilities that perform poorly risk losing their clients, which can have adverse financial effects for the firm.
Changes that can improve the Measure
Documentation is an important area that staff members should improve. Notably, some measures go unreported even when the medical staff has followed the recommended procedure. Additionally, health practitioners need to work on the errors of omission that sometimes happen. Therefore, the management must conduct proper training to remind all employees of their responsibilities. Additionally, another team that monitors daily compliance should be formed. These modifications would affect all employees. Workers must be held individually responsible for each patient they handle. Managers must strengthen their control and monitoring mechanisms.
In conclusion, core measures are key to improving the quality of service provision in the healthcare industry. Moreover, they significantly reduce ailments. Our organization has highly complied with the provisions. However, more action needs to be done to promote documentation and lower omission errors.
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References
Bulloch, M., Tapley, N., Sivaraman, B., & Parton, J. (2016). Impact of the Joint Commission pneumonia core measure on antibiotic use and selection for community-acquired pneumonia in the emergency room. Hospital Pharmacy, 51(2), 134-141. doi: 10.1310/hpj5102-134
Gonzalez, C., Johnson, T., Evans, S., Kidin, L., George, S., & Haq, S. et al. (2015). Assessing compliance with established pneumonia core measures at a comprehensive cancer center. Journal for Healthcare Quality, 37(4), 232-244. doi: 10.1111/jhq.12066
Mecham, I., Vines, C., & Dean, N. (2017). Community-acquired pneumonia management and outcomes in the era of health information technology. Respirology, 22(8), 1529-1535. doi: 10.1111/resp.13132