CMS Quality Measures: 6 Strategies for Improving Healthcare Quality

Why CMS Quality Measures Matter: 6 Strategies for Improving Healthcare Quality

With the release of its 2024 Impact Assessment Report, the Centers for Medicare & Medicaid Services (CMS) has focused attention once more on the quality measures it imposes on healthcare providers. But what are those measures, exactly, and why are they important? Here’s what employers should know, plus six key strategies to improve healthcare quality in your facility.

What Are CMS Quality Measures?

Designed to ensure quality and consistency of care for its beneficiaries, CMS quality measures are tools to define and measure standards in healthcare delivery. As such, any provider involved in a CMS program must follow their quality measures to receive reimbursement for treating Medicare and Medicaid patients.

And that’s a big portion of the population, representing more than 160 million Americans. Medicaid and CHIP programs alone serve about 20% of Americans, and 40% of all children. And Medicare is “responsible for more than one in five dollars spent” on healthcare in the United States.

Quality measures are gathered from sources like claims, standardized assessments, electronic health record (EHR) systems, and surveys of patients and providers. And from hospitals, skilled nursing facilities and home health providers to health insurers and accountable care organizations, they cover virtually every link in the chain of American healthcare delivery.

Types of CMS Quality Measures

What are the types of CMS quality measures that providers need to follow? Quality measures are classified as cost/resource, efficiency, outcome (including intermediate and patient-reported), population health quality, process, structure, and composites of any of the above:

  • Composite measures combine two or more separate, individual measures into a single score
  • Cost/resource measures evaluate cost or value spent per population or event
  • Efficiency measures compare cost to desired outcomes
  • Outcome measures focus on health status
  • Intermediate outcome measures assess changes resulting from specific interventions
  • Patient-reported outcome measures (PROM/PRO-PM) reflect direct feedback from patients and residents
  • Population health quality measures focus on a specific group
  • Process measures focus on how well procedures achieve desired outcomes
  • Structure measures assess the structural integrity of care

Examples of CMS Quality Measures

Within these parameters, examples of specific CMS quality measures vary widely. For instance, nursing homes must follow the Minimum Data Set (MDS), which features “dozens of measures” to assess quality of care. Examples include the percentage of residents who develop infections or other conditions, any increase in the proportion of those with depression or who need help with daily activities, and so on.

On the other hand, ambulatory surgical centers (ASCs) must follow the ASC Quality Reporting (ASCQR) Program, which gathers data like the percentage of patients who improve after certain treatments, receive the appropriate recommendations, or return to the hospital for an unplanned procedure within a set amount of time.

Why Do CMS Quality Measures Matter?

For most organizations, CMS quality measures are so fundamental that they’re probably already operational status quo. With the release of the 2024 Impact Assessment Report, though, it’s worth revisiting just how important they are to long-term success.

Raising Standards of Care Across Every Population

Although their original purpose is to ensure quality of care for beneficiaries, most CMS quality measures cover all of a facility’s patients. So, organizations that successfully adhere to them can boost outcomes across all populations, not just those on Medicare and Medicaid.  

Ensuring Revenue & Growth

Because of value-based care, reimbursement increasingly depends on meeting CMS quality measures. In addition, the public disclosure element can affect referrals and drive new business.

Achieving Consistency & Staying Up to Date

Because CMS services are so widely used, many private insurers based their own payment policies on them. Yet, many others don’t. What’s more, CMS quality measures aren’t even always consistent with one another, an issue that CMS leaders openly admit.

As the latest effort to resolve these inconsistencies, the 2024 Impact Assessment Report represents the most up-to-date set of quality measures — including adjustments for the Covid-19 pandemic. Providers that follow them will be best positioned for success in the years to come.

Strategies for Improving Healthcare Quality

#1: Focus on the Patient Experience

Researchers have long pointed out connections between patient experience and positive outcomes. And recent findings have explicitly connected improving the patient experience with achieving better process performance and clinical outcomes.

  • Pro tip: Providers can make sue of new tools and tech available to engage patients and enhance their experience. Some methods include offering easy online appointment scheduling, app-based payment processing, social media outreach, and more.

#2: Improve Communication & Collaboration

Effective communication with patients, residents, and families is another key strategy in improving experience and healthcare quality. It’s also a common CMS quality measure in its own right, encompassing not just effective communication with patients, but also among fellow clinical workers.

  • Pro tip: Leaders can promote staff fluency in often-used languages, especially those prominent in their communities. Regular family outreach helps avoid unnecessary frustration. And keeping team members updated on care goals, milestones, and scheduling helps promote internal engagement.

#3: Focus on Training & Career Development

Promoting training and career development opportunities helps promote better outcomes by developing and updating skills within any given department or unit. It may also help engage and retain workers — younger generations who seek mentorship and the chance to learn new skills.

#4: Improve Community Access

Patients who can’t access care rarely have positive long-term outcomes. In addition, CMS quality measures are increasingly tied to equity, or a provider’s success in treating different socioeconomic segments of its community.

  • Pro tip: Again, diversifying spoken languages can be key to ensuring equal access and improved healthcare quality. Facilities can also implement local transportation programs to help patients without cars or no access to public transit.

#5: Access Staffing Resources

Some CMS quality measures focus on quality of staffing, like how many hours each day a nursing home resident receives care from nurses and aides. Just as it does with staffing ratios, working to procure access to more workers helps meet this metric while boosting overall quality of care.

  • Pro tip: Partnering with a nationwide provider of staffing services, providers can secure access to essential workers (like contingency and travel professionals) and also ensure that they’re using them in the most cost-effective way possible.

#6: Monitor Performance

Lastly, because they can detect and correct weak points at an early stage, providers that monitor their own performance on key metrics are better positioned for stronger overall performance. It also helps make adherence to improving healthcare quality a priority for the entire organization.

  • Pro tip: While larger organizations may even have a dedicated officer and team dedicated to this task, smaller organizations may want to partner with solutions providers that can help track key metrics with the help of advanced technology.

Help Meet Your Care Quality Measures Now

At CareerStaff, we’re proud to lead the industry not just in clinical and nurse staffing but also a full suite of healthcare workforce solutions services, including managed services (MSP).

Contact us today to discover how our Joint Commission-Certified solutions can help your organization’s patient care and staffing goals — or request staff now.

Request Staff