There are several trustworthy programs that measure the quality of health care.
The Consumer Assessment of Healthcare Providers and Systems (CAHPS), a public-private initiative of the Agency for Healthcare Research and Quality (AHRQ), aims to assess consumers??? experiences with health care by developing and maintaining standardized questionnaires that can be used across various sponsors and across time to create measurement tools and resources that can be easily understood and used by consumers and providers.
The federal agency that administers Medicare, the Centers for Medicare & Medicaid Services (CMS), offers a bevy of statistics, databases and reports that show quantitative measures of their programs. These reports cover future spending estimates on Medicare and Medicaid and a broad range of consumer research, and in June, the organization publishes a booklet that provides a summary of Medicare and Medicaid program expenditures.
Another helpful tool is CMS??? five-star rating system for Medicare Advantage Plans (Part C). One star is given to plans that display poor performance, three stars for average performance and five stars for plans that show excellent performance. The ratings are based on information gathered from satisfaction surveys, plans and health care providers. There are tools on the CMS website to help consumers, their families and providers compare the quality of various health care plans.
As part of its quality improvement activities, CMS ??? in collaboration with the National Committee for Quality Assurance (NCQA), which releases an annual State of Health Care Quality report ??? launched the Medicare Health Outcomes Survey (HOS), a patient-reported survey that tracks the quality of care provided by Medicare Advantage Organizations (MAOs; also known as Part C), plans offered by private companies approved by Medicare. The survey ensures that all medical care programs paid for by Medicare meet professional standards.
The most recent iteration of the program ??? HOS 2.0 ???comprises four primary components. These are the Veterans RAND 12 Item Health Survey (VR-12), which provides summaries of the physical and mental health of patients; questions to gather information for case-mix and risk adjustment; four Health Care Effectiveness Data and Information Set (HEDIS) measures, which are widely used and therefore helpful in comparing the quality of care between providers; and additional health questions.
Another reliable place for quality care information are the case files of the Independent Review Entity (IRE), which evaluates the appeals of Medicare recipients who disagree with the initial decisions on their claim. Patients have the right to appeal the decisions on Medicare services, whether the patient has the Original Medicare (also known as traditional Medicare; Original Medicare includes hospital insurance (Part A) and medical insurance (Part B)), a Medicare managed plan (Part C), or a Medicare Prescription Drug Plan (Part D). Reconsideration case files are stored for seven years from the end of the calendar year in which final action is taken.
The notices must be written clearly, be culturally competent and take any of the enrollee???s special requirements into consideration, including medical conditions, disabilities and language needs.