JANUARY

UNITED STATES
The Institute of Medicine (IOM), an independent nonprofit organization that works outside of government, acts
as an adviser to policymakers and the private sector on improving the nation’s health. Stakeholder associations
(e.g., the American Medical Association) comment on and lobby for policies affecting the health system.
The independent, nonprofit Joint Commission accredits more than 20,000 health care organizations across the
country, primarily hospitals, long-term care facilities, and laboratories, using criteria that include patient
treatment, governance, culture, performance, and quality improvement. The National Committee for Quality
Assurance, the primary accreditor of private health plans, is responsible for accrediting the plans participating
in the newly created health insurance marketplaces. The nonprofit National Quality Forum builds consensus
on national performance priorities and on standards for performance measurement and public reporting. The
American Board of Medical Specialties and the American Board of Internal Medicine provide certification to
physicians who meet specified standards of quality.
What are the major strategies to ensure quality of care?
In 2011, the Department of Health and Human Services released the National Quality Strategy, a component of
the ACA that lays out national aims and priorities to guide local, state, and national quality improvement efforts,
supported by an array of partnerships with public and private stakeholders. Current initiatives include efforts to
reduce hospital-acquired infections and preventable readmissions (see below).
CMS has moved toward increased public reporting of provider performance data in an effort to promote
improvement. One such initiative is Hospital Compare, a service that reports on measures of care processes,
care outcomes, and patient experience at more than 4,000 hospitals. In additional, with support from the ACA
and such groups as the Open Government Partnership, CMS is making Medicare data available to “qualified
entities,” such as health improvement organizations, which are beginning to release data on payments made
by Medicare to individual physicians and amounts paid to physicians and hospitals by pharmaceutical and
device companies. Release of such information is intended to both increase transparency and improve quality.
States have developed additional public reporting systems and measures, including some that address
ambulatory care. Consumer-led groups, such as Consumers Union and the Leapfrog Group, also report on
quality and safety.
Incentives to reduce avoidable hospital readmissions among Medicare patients were introduced in October
2012, by way of financial penalties. Since the program’s initiation, 20-day readmission rates nationally have
declined from 19 percent to less than 18 percent (Blumenthal et al., 2015). Incentives to reduce hospitalacquired
conditions, by reducing Medicare payments to the lowest-performing hospitals by 1 percent, were also
introduced. Recent data show the first-ever decline in rates of hospital-acquired conditions nationally
(Blumenthal et al., 2015).
Finally, Medicare, and the majority of private insurance providers, is implementing a variety of pay-for-value
programs. Starting in 2013, 1 percent of Medicare payments are redistributed to the highest performers on a
composite of cost and quality measures. The program was introduced to physicians in 2015 on a voluntary basis
and is expected to become mandatory by 2017. As yet, results are too preliminary to draw conclusions
(Blumenthal et al., 2015).
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The Commonwealth Fund