If you think of quality assurance solely in industrial settings, think again. The assurance of quality is a hallmark of health care and, with the adoption of pay-for-performance and evidenced-based medicine, it is becoming more important and more visible.
In healthcare institutions, quality assurance (QA) teams work throughout the system to design policies and procedures that promote the best possible patient outcomes. That means ensuring compliance with a multitude of regulations, policies, and laws at the federal, state, and local levels, as well as developing internal strategies to support quality healthcare delivery and the overall health of the community the organization serves.
Why Quality Matters
Today, hospitals are ranked according to patient outcomes. With these statistics in hand, patients can choose the best hospital for their specific diagnosis or condition and physicians can choose to have privileges at top-notch hospitals.
Reimbursement also depends on outcomes. Using value-based principles, public and private insurers now base reimbursement rates upon outcomes. For example, under the pay-for-performance stipulation in the Affordable Care Act, hospitals with excessive readmissions may receive lower reimbursements by Medicare and Medicaid for procedures such as heart failure, than hospitals with better outcomes for patients who have the same conditions and severity of disease.
What a QA Team Does
Therefore, to improve patient outcomes and hospital reimbursement, healthcare organizations rely on quality assurance teams. QA professionals identify areas needing focus, set quality goals, develop strategies, collect and analyze before-and-after data, integrate programs with those of other departments, and work to facilitate team-building throughout the organization. As compliance specialists, QA professionals also ensure their medical facilities adhere to all relevant federal, state, and local laws and regulations, including provisions of third-party payers. In addition, they also ensure their health care organizations meet criteria for accreditation by relevant accrediting organizations.
QA programs typically focus on three areas: Structures, processes, and outcomes. Some specific activities may include:
- :: Monitoring the proportion of board-certified physicians available to patients, which correlates to quality of care.
- :: Completing the transformation to electronic medical records. (Although 96 percent of non-federal acute care hospitals use health IT, children’s hospitals and those in small rural areas lag behind.)1
- :: Encouraging preventive care and wellness programs to avert illness and improve the health of those already diagnosed with a disease.
- :: Tracking patient outcomes (measured by complications, readmissions, and mortality) to link therapies and policies to efficacy, which affects reimbursement rates from third-party payers.
Skills and Qualifications
Quality assurance professionals, whether compliance specialists or QA managers or coordinators, need a broad range of skills to manage quality in the complex healthcare environment. Success requires deep knowledge of healthcare laws and regulations, institutional rules, personnel management, and medical records management as well as healthcare operations. It also requires a few years of experience in the healthcare field.
Because a robust quality assurance program uses a variety of data and resources, QA managers also must be adept at integrating data and identifying the most-relevant elements. They must also be able to communicate findings clearly in discussions, as well as through detailed analytical reports.
Healthcare is entering one of its most dynamic eras, as new regulations and new therapies change the very nature of the profession. If you are interested in this exciting field, contact Utica College to learn about its online Health Care MBA.