Hospital Core Measures Defined

Posted on December 31, 2020
Tags: Hospital

In an increasingly competitive industry, hospitals can use performance data to stay in compliance with The Joint Commission (TJC) and expedite reimbursements from Centers for Medicare and Medicaid Services (CMS) and signal to the community their commitment to excellence. And while hospitals may see thousands of different ailments and symptoms every year, a select group of treatment guidelines for the most common conditions has been designated as “core measures.” These treatment plans have a proven record of increasing positive outcomes and resulting in better patient care for hospitals adhering to them.

What Are Hospital Core Measures?

The U.S. healthcare system moves from a model that pays for the volume of services to one that pays for the value of services. That said, value-based payment requires measures on quality, patient experience, and efficiency to assess these models’ success and how well hospitals are delivering value. This is where common quality measures come into play.

Hospital core measures are a set of national standardized best practices and recommended actions that are statistically proven to improve patient outcomes. TJC and CMS regularly review hospitals for their compliance rates, and patients and families can use these measures to compare various hospitals and treatment facilities. Core measures are based on the most common condition’s hospitals see, such as acute myocardial infarction (AMI), heart failure (HF), pneumonia, surgical care, children’s asthma care, venous thromboembolism (VTE), stroke, and more.

Hospitals report on these measures quarterly or monthly, and compliance can affect TJC accreditation and CMS reimbursement. While these are significant results, of course, the critical benefit of core measures is that hospitals can use them to actively promote quality patient care and their progress towards 100% compliance.

Who Created Core Measures?

After gathering input for two years from various stakeholders, in 2001, TJC established four initial core measurement areas for hospitals, including AMI and HF. Simultaneously, it began working with CMS on these two specific measures, as they were common to both organizations. By 2003, the two organizations were working to completely align these standard measures, resulting in the creation of one common set of measure specifications documentation known as the Specifications Manual for National Hospital Inpatient Quality Measures. The manual works to reduce data collection efforts by standardizing items like a common data dictionary, measuring information forms, algorithms, and more.

How Are Core Measures Selected?

TJC and CMS select core measures using a set of criteria to help focus efforts and address the most common conditions. Core measures are typically dividing into two groups – adult and pediatrics – and focus on conditions that:

  • Represent national public health priorities
  • Are common to health disparities
  • Disproportionately drive healthcare costs and could improve with better quality measurement
  • Contribute to the morbidity and mortality of the most CMS beneficiaries
  • Can be measured in new ways, increasing insight into care across the spectrum
  • Include measurable patient and/or caregiver engagement

Using these standards helps ensure focus on the most pressing issues and conditions and the promise of specific, measurable data that can be checked for improvement and compliance.

What Areas Do Hospital Core Measures Cover?

Every year, collaborative workgroups help refine existing core quality measures (CQM), address gaps, and prioritizing areas for future core set development. Additionally, these groups work to develop strategies for adoption across payers and programs to promote alignment. Guidelines are established for:

  • Accountable Care Organizations/Patient-Centered Medical Homes/Primary Care
  • Behavioral Health
  • Cardiology
  • Gastroenterology
  • HIV & Hepatitis C
  • Medical Oncology
  • Neurology
  • Obstetrics & Gynecology
  • Orthopedics
  • Pediatrics

The Core Quality Measures Collaborative (CQMC) – a broad-based coalition of more than 70 healthcare organizations working to facilitate cross-payer measure alignment – enables these regular workgroups and publishes a free implementation guide. It also publishes documents outlining guidelines for each of the 2020 core sets.

Why Do Core Measures Matter to Hospitals?

Adherence to providers and staff’s core measures is vital in helping hospitals improve patient care and satisfaction while also maintaining key accreditation and ratings. Core measures are directly tied to:

  • Better patient care: By following the recommended actions for each core set, hospitals are utilizing proven and well-researched best practices to improve outcomes. This directly supports the hospital’s objective to deliver top care to the community.
  • More Efficient Reimbursement: Under the CMS Hospital Value-Based Purchasing (VBP) Program, CMS looks at how well the hospitals perform on specific quality measures compared with other hospitals, and how much the hospitals’ performance improves on quality measures from their performance during a baseline period.
  • Increased Business from the Public: Results of common measures are available for review by potential patients and family members. This can affect where people proactively choose to go for preventative care and higher acuity cases where destination locations can be selected for EMS transport.

How Software Assists in Meeting Core Measure Standards

Although the benefits are undeniable, the number of core measures can at first seem daunting. It’s imperative that data collected and reported on is accurate and easily gathered over a period of time. Additionally, many of the measures involve time-based variables, making it essential for doctors and nurses to easily and accurately create records when needed. For example, even in the high-stress environment of the ED, it’s important to be able to track median time from ED arrival to ED departure for admitted patients or admit decision time to ED departure time for admitted patients.

A useful tool for hospitals is reliable and easy to use software, designed specifically for hospital reporting. From electronic patient care records (ePCRs), patient registries, and analytics tools, these digital tools make gathering, analyzing, and reporting on a large amount of data more reliable and efficient than ever. Easy-to-use tools like ESO ecosystem of software for hospitals can assist officers and managers in actively improving on standard measures and getting easier alignment from all staff needing to participate.

Additionally, easier collaboration and communication with your prehospital partners and EMS agencies can give more insight into your hospital’s performance on common measures and more. Sharing patient records with EMS agencies can highlight how to improve various measures, including being better prepared for incoming calls and making the most of field impressions to cut down on time to diagnosis. Software like ESO Health Data Exchange allows bidirectional data sharing of patient information in a secure environment, benefitting both hospitals and EMS agencies.

For more information on the software tools designed to help hospitals gather, report, and analyze core measures more efficiently, see the full suite of ESO Software Tools for Hospitals.

Or take a tour now of ESO Health Data Exchange now to learn more about improving communication between hospitals and EMS agencies.