Ask the payment expert ... about quality metrics

Patricia Boyer, MSN, NHA, RN
Patricia Boyer, MSN, NHA, RN

I hear a lot of references to “quality metrics.” What does this mean?

A metric is a measurement of some sort of factor. For a quality metric, we are measuring quality in your facility. Companies measure performance against quality standards to determine whether they're meeting expectations. This measurement may be compared to benchmarks by labor market, by state or by national prevalence.  

For example, the Five-Star program measures the quality metrics of survey results, staffing and quality measures. The Centers for Medicare & Medicaid Services recently changed the Five- Star metrics calculations so that many facilities decreased in their star rating. Now facilities are complaining that they are being judged differently than they were prior to these changes. 

In addition, your tracking and trending of falls, pressure ulcers and infection are all quality metrics.

With the development of accountable care organizations, and the government's focus on changing payment systems, quality metrics are becoming increasingly important to determine how your facility compares to others. As time progresses, the expectation is that only the facilities which stand out among their peers are going to be the winners in forming collaborations with hospitals and other networks.  

Now is definitely the time to be talking to your referral hospitals and any ACOs that are developing in your geographic area to find out what quality metrics they are interested in. Building internal systems to begin or continue that tracking and trending will also positively position your facility. We are in a changing environment in healthcare, and the survivors will be those who look ahead and work today to improve their quality outcomes. All future payment systems will be tied to those quality metrics.