History and Overview of the National Quality Strategy

Abstract

Some of the best medical care in the world is available in the USA, yet there is growing evidence that our delivery of high-value clinically coordinated care is below the standards of many other countries. The progress of quality improvement in the USA dates back to the early twentieth century, but it accelerated in the 1960s and 1970s with the work of Avedis Donabedian and others. Our current quality improvement initiatives have been organized within the National Quality Agenda that is part of the 2010 Patient Protection and Affordable Care Act. The National Quality Forum, Centers for Medicare and Medicaid (CMS), and the Agency for Health Care Research and Quality are leaders in developing quality measures, validating their impact, and facilitating implementation. Gastroenterology societies including the American Gastroenterological Association, American College of Gastroenterology, and the American Society for Gastrointestinal Endoscopy have built programs available to practicing clinicians to help practices enhance their patient care and demonstrate quality in the services we provide patients. It is clear from recent and emerging legislation that CMS is leading the way away from a fee for service reimbursement methodology to one based on demonstrated quality. This concept will change our focus from solely one of quality to a focus on “value” where value refers to quality health outcomes per unit cost. Incorporation of the financial consequences of our medical care and moving toward increasing provider, practice and health system accountability will inevitably alter the way medical care is delivered in the USA. These and other concepts are outlined in detail in this and other chapters of this book. Gastroenterologists who understand the value equation and can link that to their practice strategy will become valued partners for the large consolidating health systems we are witnessing and to the insurance companies that are slowly but surely narrowing their provider networks.