Quality Spine Care: Healthcare Systems, Quality Reporting, and Risk Adjustment

Description

Quality reporting is a rapidly growing area. Each year, new regulations in the US from the Council of Medicare and Medicaid Services make quality reporting a larger factor in determining reimbursement practices. Quality metrics are common parts of European clinical practice. Value of care is a focus of all payers, with specific interest directed at assessing the quality of care provided by a given healthcare team. While there are many publications in this space, no text has sought to provide an overview of quality in spine care. Quality measurement and quality reporting are ever growing aspects of the healthcare environment. Quality assessment is valuable to all healthcare stakeholders: patients, physicians, facilities, and payers. Patients are drawn to facilities that provide high value care; public reporting systems and grading systems for hospitals offer one opinion with regard to “high quality care.” Most physicians email inboxes are inundated with offers of recognition for being a “Top Doc” for a nominal fee. Some payers offer incentives to patients who chose to be treated at “Centers of Excellence” or similar facilities; the definition of “Excellence” may be unclear. There is little consensus on how to measure quality, how to incorporate patient and procedure factors and achieve accurate risk adjustment, and how to define value of care. Regardless of these challenges, regulatory efforts in the US, as well as numerous international efforts, make quality assessment and quality reporting an important part of physician behaviour. Physician and facility reimbursement for procedures are often tied to quality metrics. Spine procedures are costly, elective, and are a focus of many payer-based programs. Hence, spine care is often a focus of quality reporting efforts. This text summarizes the state of the art with regard to quality measurement, reporting, and value assessment in spine care. We will review quality reporting in the US and internationally. Chapters will outline how quality improvement efforts have achieved success in hospital systems. The reader will be provided with insights in how to achieve success incorporating quality metrics into spine care. Features: 1. Illustrates the state of the art in spine quality reporting: There is no text that thoroughly addresses quality assessment and quality reporting in spine care; there are, however, numerous articles in this space. This book provides a definitive text covering the state of the art for quality reporting in spine care and will be of value to the international orthopedic and neurosurgical spine community. 2. Provides insight on quality reporting in different healthcare systems: The text will allow for comparison of different quality reporting systems from different health care systems. This will provide practitioners with insight into the strengths and weaknesses of different approaches to quality reporting, and may drive improvement in quality assessment and reporting systems. A single text that features review of US, European, and Australia/Asian health care systems’ quality reporting is novel and will be thought provoking for readers. 3. Describes the US and international Healthcare reimbursement systems: Practicing physicians are provided with little information and less insight into the vagaries of the US and other healthcare systems. The text will provide insight into code development, valuation, and how quality reporting affects physician reimbursement 4. Explains risk adjustment: Appropriate risk adjustment and assessing patient and procedure factors that may impact quality reporting are invaluable to accurate quality measurement. The text will review risk adjustment, different approaches to risk assessment/mitigation, and provide physicians with insights into appropriate measures to capture in their clinical practices 5. Provides a foundation for improved quality assessment in spine care: While there are many disparate elements and differing approaches to capturing spine quality metrics, no definitive text has attempted to summarize these efforts in a single volume. By synthesizing these variable approaches, the reader may be provided with insights into superior approaches to quality assessment and a foundation will be provided for improving healthcare systems. Front Matter ....Pages i-xxi Front Matter ....Pages 1-1 Historical Aspects of Quality in Healthcare (Omid R. Hariri, Ariel Takayanagi, T. J. Florence, Arvin R. Wali)....Pages 3-13 Quality and Standardization of Medical Education (Jonathan P. Scoville, Erica F. Bisson)....Pages 15-28 The History of Quality Assessment in Spine Care (Eric J. Feuchtbaum, Catherine H. MacLean, Todd J. Albert)....Pages 29-49 Front Matter ....Pages 51-51 Choice of Quality Metrics for Assessment of the Spine Patient (Taylor D. Ottesen, Kareem J. Kebaish, Jonathan N. Grauer)....Pages 53-68 Patient-Reported Outcomes (Melissa R. Dunbar, Zoher Ghogawala)....Pages 69-73 Registries in Spine Care in the United States (Owoicho Adogwa, Joseph Cheng, John E. O’Toole)....Pages 75-88 Registries in Spine Care: UK and Europe (Bernhard Meyer, Ehab Shiban, Sandro M. Krieg)....Pages 89-110 Concepts of Risk Stratification in Measurement and Delivery of Quality (Tejbir Singh Pannu, Virginie Lafage, Frank J. Schwab)....Pages 111-129 Risk Adjustment Methodologies (Zach Pennington, Corinna C. Zygourakis, Christopher P. Ames)....Pages 131-151 Front Matter ....Pages 153-153 Healthcare Systems in the United States (Luis M. Tumialán)....Pages 155-169 The National Health Service (NHS) in England: Trying to Achieve Value-Based Healthcare (Ashley A. Cole, Lee M. Breakwell, Michael James Hutton)....Pages 171-198 Quality Spine Care in Australasia (Bryan Ashman, John Chen Li Tat)....Pages 199-209 Healthcare Systems: India (Satish Rudrappa, Deepak Venkatesh Agarkhed, Sushrut S. Vaidya)....Pages 211-224 Healthcare Systems and Quality Assessment of Spine Care in Japan (Motoki Iwasaki, Takahito Fujimori)....Pages 225-236 Overview of Healthcare System in China (Xiongying Chen, Xiang Qian)....Pages 237-254 Front Matter ....Pages 255-255 Conditions of Care and Episode Groups (Mohamad Bydon, Mohamed Elminawy, Mohammed Ali Alvi)....Pages 257-271 Aligning Healthcare Systems (Gabriel S. Makar, Michael Gutman, Mayan Lendner, David A. Janiec, Christina Vannello, Michael E. West et al.)....Pages 273-285 Building Quality Metrics into a Practice (Clemens M. Schirmer)....Pages 287-300 Impact of Quality Assessment on Clinical Practice, Intermountain Healthcare (Mark J. Ott, Griffin H. Olsen)....Pages 301-313 Impact of Quality Assessment on Clinical Practice, Kaiser Permanente (Kern H. Guppy, Jessica Harris, Johannes A. Bernbeck, Harsimran S. Brara)....Pages 315-339 How Quality Is Assessed in Insurance Markets (Catherine H. MacLean, Chad M. Craig)....Pages 341-354 Centers of Excellence and Payer-Defined Quality Assessment (Daniel Burkett, Clayton Haldeman, Paul Samuel Page, Daniel K. Resnick)....Pages 355-367 Reporting Quality Results (Julian L. Gendreau, Allen L. Ho, Arjun Vivek Pendharkar, Eric S. Sussman, Atman M. Desai)....Pages 369-384 Achieving Success in Quality Reporting (Brian L. Anderson, Pratik Rohatgi, Robert E. Harbaugh)....Pages 385-395 Back Matter ....Pages 397-405