Everyone talks about quality but other than patient surveys is there a written definition of quality that does not include cost?

A: In recent years there has been a significant shift in Medicare payment policy away for FFS payment toward payment methodologies that are linked to quality of care. CMS has stated that the goals of the CJR payment model are to improve quality of care and cost efficiency. Incorporating quality performance into the episode payment structure is a necessary component of the CJR program. One measure of quality can be linked to a lower rate of complications related to the procedure. Specifically, if a provider is able to significantly decrease the cost of the procedure, but experiences an increase in the number and significance of complications this would be an indicator of poorer quality of care.

CMS uses the Hospital-Level Risk-Standardized Complication Rate (RSCR) following Elective Primary Total Hip Arthroplasty (THA) and/or Total Knee Arthroplasty (TKA) (NQF#1550), which is currently implemented in the Hospital inpatient Quality Reporting (HIQR) and Hospital Value-Based Purchasing (HVBR) program and assesses the hospital’s risk standardized complication rate as a measurement of this quality.

The following outcomes (one or more) are considered complications in this measure:

• acute myocardial infarction; 
• pneumonia, or sepsis/septicemia within 7 days of admission; 
• surgical site bleeding, pulmonary embolism or death within 30 days of admission; or
• mechanical complications, periprosthetic joint infection, or wound infection within 90 days of admission.