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The nurse's role in CMS quality indicators.

Article Excerpt
Nurses know about the quality of health care in their institutions; that is one benefit of their positions. How does the general public know about the quality of care at a given institution? What defines "quality of care"? How can the quality of care be improved? Some answers can be found in the Hospital Quality Initiative, a project of the U.S. Department of Health and Human Services (HHS, 2009) and the Centers for Medicare & Medicaid Services (CMS) in conjunction with other groups (CMS, 2008) (see Figure 1). Empowering consumers with quality-of-care information to make informed decisions, driving improvement in the quality of care, and increasing accountability for the expenditure of health care dollars are key goals of HHS and CMS. The Hospital Quality Initiative was announced in 2001 with 10 quality indicators for six conditions. Today, this program includes more than 20 parameters for acute care hospitals, commonly known as the CMS quality indicators. The nurses' roles in providing quality care as defined by the Hospital Quality Initiative are explored.



Figure 1. Participants in the Hospital Quality Alliance * American Hospital Association * Federation of American Hospitals * American Association of Medical Colleges * American Medical Association * American Nurses Association * National Association of Children's Hospitals and Related Organizations * American Association of Retired People * American Federation of Labor and Council of Industrial Organizations * Consumer-Purchaser Disclosure Project * Agency for Healthcare Research and Quality * National Quality Forum * Blue Cross and Blue Shield Association * National Business Coalition on Health * General Electric * U.S. Chamber of Commerce Source: CMS, 2008.

Key Aspects of the Hospital Quality Initiative

While the details of the quality indicators evolve, the three basic tenets of the Hospital Quality Initiative remain constant: reporting, improving care, and reimbursement (CMS, 2008).

Reporting. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 began the implementation of the Hospital Quality Initiative (CMS, 2008). Under this law, reporting was considered to be voluntary, but with strong incentives (lower financial reimbursement for non-reporting hospitals). The use of financial incentives for reporting has evolved and is discussed later. The Hospital Quality Initiative was designed to improve the quality of patient care by publicly reporting a standardized set of easy-to-understand hospital quality measures. The intent was to use public reporting as competition to drive the quality of care. Public reporting occurs through the Internet (http://www.hospitalcompare.hhs.gov).

Improving care. CMS quality indicators are performance measures of evidence-based care, both nursing and medical, provided to patients in acute care hospitals. CMS quality indicators...

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