A sign of poor care might be noticed if a facility or a gastroenterologist had a higher percentage of patients admitted within days of an outpatient endoscopy or colonoscopy, a measure suggested by CMS. This could indicate problems with perforations or infections, and would be a marker of poorer quality of care.
Services provided in a variety of settings made it onto the MUC this time, from ambulatory surgery and dialysis centers to home health and long-term hospital care, in addition to emergency departments and cancer treatment centers.
This year more than in the past, the MUC includes more than a dozen functional outcome measures that are reported by the patient, which many physicians, payers, and patients say are much more important than process measures that currently dominate quality programs today. For example, patients with congestive heart failure might be asked to define a target improvement goal, and the measure would rate providers on whether the patients met that goal they set for themselves.
Another such measure counts the number of total hip arthroplasty patients who assessed themselves as having improved function after surgery.
These patient-reported measures are important because they come directly from the patient's experience and perceptions, "not just from information from clinical records or claims data," Kramer says.
Additionally, Kramer says, "there's more measures of cost and efficiency, or total resource use" in the MUC. For example, for several diseases and conditions providers would be rated on the cost and use of resources during an episode of care—and whether a care team talked with patients about the cost of their prescription drugs.