Haley Evans
5 min readDec 16, 2021

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Low Quality Healthcare Caused by COVID-19

According to WHO, coronavirus disease (COVID-19) is an infectious disease caused by the SARS-CoV-2 virus. Most people infected with the virus will experience mild to moderate respiratory illness and recover without requiring special treatment. However, some will become seriously ill and require medical attention. Older people and those with underlying medical conditions like cardiovascular disease, diabetes, chronic respiratory disease, or cancer are more likely to develop serious illness. Anyone can get sick with COVID-19 and become seriously ill or die at any age.

It’s fair to say, that although this is a scientific definition, all have a different way of interpreting COVID-19. Maybe it’s by one’s personal experience, or a loved one, or the changes in life that occurred. The list goes on and on, but one thing that has been overlooked is how drastically quality indicators have changed in while providing care for COVID-19 patients.

What are Quality Metrics?

Quality measures are tools that are used to measure or quantify healthcare processes, outcomes, patient perceptions, and organizational structure and/or systems that are associated with the ability to provide high-quality health care and/or that relate to one or more quality goals for health care.

These goals include: effective, safe, efficient, patient-centered, equitable, and timely care.

Why are they used and how did they start?

CMS uses quality measures in its quality improvement, public reporting, and pay-for-reporting programs for specific healthcare providers.

In 1965, Congress passed legislation which established the Medicare and the Medicaid programs as Title XVIII and Title XIX of the Social Security Act. In anticipation of the need to assess and direct the care of Medicare patients, Congress established a set of conditions entitled “Conditions of Participation,” which required the implementation of several elements deemed necessary for hospital operation. Several years later, in response to the ineffectiveness of the 1965 Utilization Review Committees, Congress established pilot organizations entitled “Experimental Medical Care Review Organizations” in 1972. Based on the success of the pilot Experimental Review Organizations, PSRO legislation created a federally funded network of nonprofit physician-run organizations, tasked with assessing the necessity, applicability, and quality of healthcare services rendered. Over the period from 1995 to 2000, several quality improvement initiatives, task forces, and sentinel reports were initiated and published. The Institute of Medicine (IOM) launched the comprehensive quality initiative, the Joint Commission established the sentinel event policy, the Quality Interagency Coordination Task Force (QuIC) was established, the Leapfrog Group was founded, and the IOM published the transformative article “To Err is Human” followed by “Crossing the Quality Chasm” .

In short, the government has aided in pushing healthcare organizations to establish best practices and aid in the establishment of healthcare high reliability organizations. When done correctly, reimbursements are increased, patients are satisfied and safe, as is the employees.

Money talks, right?

Quality and COVID?

COVID-19 has highlighted a number of strengths and weaknesses in the US health care system. One strength is the efforts and continual dedication of healthcare workers to provide the best care to patients even in the most trying conditions. Due to how fast COVID-19 appeared many more unknowns than knows, clinicians were unable to high quality care with the world changing daily, somedays hourly.

March 2020

In March 2020, the Centers for Medicare & Medicaid Services (CMS) announced the granting of wide and sweeping exceptions for the collection and submission of data for Medicare quality programs, citing the need for hospitals and clinicians to focus on preparation for a potential surge of patients. It wasn’t just known to each individual but it was known the the government that, this is an unpresented time, that cannot be truly represented by quality indicators on one progress towards the CMS goals established.

If Money Talks, What’s Next?

While some measures were suspended, other quality measures and incentives were developed to encourage clinician participation in deploying novel treatments and therapeutics. CMS leveraged its existing value-based care initiatives and payment and reimbursement mechanisms to promote COVID-19 vaccination as part of their ongoing value-based care initiatives for Medicare Exchange and Advantage plans. Money continued to be given to healthcare facilities but ideally, it isn’t going to be this way forever. So, priorities need to be set to help quality and safety.

Set Priorities off of Lessons Learned

Ongoing systematic review of CoPs in consideration of requirements related to prolonged stresses on the health care system, including how various care settings can work more closely together to address issues of a surge of hospitalizations, support for home care, and coordination of discharge or transfer from one setting to another.

Acceleration of the work begun pre-COVID-19 to strengthen and modernize the quality measurement strategy and infrastructure.

Expanding and rapidly accelerating the shift away from fee-for-service models and toward alternative payment that promotes value and optimizes population wellness, resilience, and patient outcomes.

Investing in the expansion of digital data capture in public health and congregate settings, ensuring the data are fully interoperable and expanding public-private partnerships to accelerate innovation and agility in the digital information and measurement space.

“With robust strategic investments and partnership by the public and private sectors and a cadre of leaders committed to transformational change, the quality, safety, and standards organization sector can emerge from the COVID-19 pandemic smarter, fairer, and stronger than before.”

References:

Carolyn Clancy, K. G. (2021, August 30). Quality, safety, and standards organizations COVID-19 impact assessment: Lessons learned and compelling needs. National Academy of Medicine. Retrieved December 16, 2021, from https://nam.edu/quality-safety-and-standards-organizations-covid-19-impact-assessment-lessons-learned-and-compelling-needs/

J. Matthew Austin, P. D. (2020, July 28). The state of health care quality measurement in the era of covid-19-the importance of doing better. JAMA. Retrieved December 16, 2021, from https://jamanetwork.com/journals/jama/fullarticle/2767747

Marjoua, Y., & Bozic, K. J. (2012, December). Brief history of quality movement in US healthcare. Current reviews in musculoskeletal medicine. Retrieved December 16, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3702754/

Quality measures. CMS. (n.d.). Retrieved December 16, 2021, from https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityMeasures

World Health Organization. (n.d.). Coronavirus. World Health Organization. Retrieved December 16, 2021, from https://www.who.int/health-topics/coronavirus#tab=tab_1

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