TABLE 5.
Some Current Medicare or Medicaid Initiatives Concerning Quality and Value
| Safe (No Harm) | Effective (No Needless Failures) | Efficient (No Waste) | Patient Centered (No Helplessness or Care Barriers) | Timely (No Needless Delays) | Equitable (No Unjustified Variation) | |
|---|---|---|---|---|---|---|
| 1. Healthy | Voluntary physician's office reporting | Immunization, cancer screening | Electronic records | |||
| 2. Maternal and infant health | ||||||
| 3. Acutely ill, but mostly curable | Correct treatment for pneumonia, heart attacks | H-CAHPSa | Rapid treatment for pneumonia, heart attacks | |||
| 4. Chronic conditions, normal function | Fistula First for dialysis; voluntary physician's office reporting | Diabetes management, CHF/COPDb and high-cost demos; adequate dialysis | Risk contracts in demos | AMB-CAHPSa | ||
| 5. Stable with significant disability | Survey/certification, nursing home and home care quality | Home/community waiver evaluations | Resources follow patient's initiative | Enforcement of Americans with Disabilities Act | ||
| 6. Short period of decline near death | Hospice quality | Rural hospice and advance planning demonstrations | Hospice plan of care | |||
| 7. Exacerbations, organ system failure | Chronic condition demonstrations | Care management demonstrations | Self-care classes; advance planning demonstration | |||
| 8. Long dwindling course | Pressure ulcer prevention; no restraints; survey/certification, nursing home and home care quality | Pain treatment in nursing homes | Home and community waivers | NH-CAHPSa | ||
a
CAHPS is the Consumer Assessment of Healthcare Providers and Systems, with a version for hospitals (H-CAHPS), ambulatory care (AMB-CAHPS), and nursing homes (NH-CAHPS).
b
CHF = chronic heart failure; COPD = chronic obstructive pulmonary disease.