Question

Explain Federal regulations and mandates driving healthcare quality such as CMS

Answer 1

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CMS' Center for Clinical Standards & Quality (CCSQ), led by the CMS Chief Medical Officer and the CCSQ Leadership Team, is a cadre of professionals with diverse backgrounds in clinical, scientific, public health, legal, IT, project management, academic, and business management fields. We serve CMS, HHS, and the public as a trusted partner with a steadfast focus on improving outcomes, beneficiaries' experience of care, and population health, while also aiming to reduce healthcare costs through improvement.

The care of elderly Americans has traditionally involved consideration of the progressive nature of their chronic conditions and evolving treatment strategies that aim to minimize the long-term complications of these conditions. However, today’s practitioners must also be attentive to problems involving insurance coverage and payment for each patient—commercial or public sector. Several trends in the nation’s health insurance marketplace are dictated by actions at the federal level, especially the legislative branch. In the previous decade, public and private insurers had to continuously adapt to many overarching federal initiatives, primarily the passage and implementation of the ACA and Centers for Medicare & Medicaid Services (CMS) regulatory initiatives and the efforts to rein in the high federal budget deficit

Quality Improvement Organizations

Successful quality initiatives rely on partnerships and support from many sources that encompass the healthcare community such as federal and State agencies, researchers and academic experts, stakeholder and consumer organizations, providers and advocates, and federal contractors such as Quality Improvement Organizations (QIOs). QIOs can assist Medicare beneficiaries and their caregivers understand and use quality measures information in their healthcare decision making process.

Quality Measures

CMS has developed a standardized approach for the development of quality measures that it uses in its quality initiatives. Known as the Measures Management System (MMS), this system is composed of a set of business processes and decision criteria that CMS funded measure developers follow in the development, implementation, and maintenance of quality measures.