Manager of Value Measurement Amy Moyer explains how doctors and hospitals qualify for QualityPath designation.
What are the QualityPath quality standards?
Quality standards are built on evidence-based practices that contribute to better results for patients, including:
- Appropriate Use of Imaging, which means decision to use high-tech imaging is based on clinical evidence so patients get high-value care without unnecessary exposure to radiation.
- A Patient-Centered Process, which means patients are fully informed and have a voice in important decisions, including whether to have the procedure and at what point.
- Transparency, which means hospitals and doctors share the results of procedures with registries to improve quality measurement as well as offering information to patients.
- Positive Patient Outcomes, which means hospitals and doctors have a proven record of working together to achieve good patient outcomes for specific procedures.
How do doctors and hospitals qualify for QualityPath?
Doctors and hospitals that perform elective procedures as part of QualityPath annually complete an extensive application process that includes a review of past outcomes for these procedures as well as the implementation of important standardized clinical processes. They also agree to provide care at a bundled price that covers all elements of the procedure and to offer a warranty to cover the cost of complications. QualityPath is a voluntary program and any facility that offers these procedures can apply.
How are hospital and doctor applications reviewed?
First, all identifying information is removed from the hospital and doctor responses to our request for information (RFI). This task is handled by a group of Alliance staff who were not involved in the review process.
Removing the identification from the RFI responses is important because:
- It keeps the review team free from being influenced by any pre-conceived ideas about a hospital or doctor.
- It maintains the confidentiality of applicants.
Next, the “de-identified” responses are reviewed separately by the manager of value measurement and a team of nurse reviewers from Metastar, a quality improvement organization. Each reviewer scores the responses against a template, determining whether each criterion was met or not. Any scoring differences are discussed and resolved.
A summary of the initial review and the de-identified responses are then presented to the full review team. This team reviews the scoring and discusses the responses. In 2014, the review team consisted of:
- Amy Moyer, Manager of Value Measurement, The Alliance
- Mark Xistris, Vice President Business Development and Provider Relations, The Alliance
- Cheryl DeMars, CEO, The Alliance
- Dianne Kiehl, CEO, Business Health Care Group
- Jerry Reeves, MD, Vice President of Medical Affairs, HealthInsight Nevada (Physician Consultant to QualityPath)
- Gail Amundson, MD, Healthcare Transformation Consultant
Once decisions are made and evaluations are finalized, the identifying information is restored. The review team holds conference calls with each applicant to discuss the evaluation results. Once the calls are completed, each applicant receives written feedback including any gaps that must be closed in order to fully meet the criteria.