Buzzword of the Week: Core Measures

One of the sigh-inducing buzzwords I’ve heard thrown around at meetings more than ever this year is “core measure”.  Draw blood cultures bzefore giving antibiotics, administer pain medication for a long bone fracture within one hour of arrival to the emergency department…blah, blah, blah.  While I understand the general gist of core measures, keeping up with them can be exhausting and seem pointless at times.  So, I decided to investigate a bit further to see just what core measures are all about.

How Did Core Measures Come About?

Since the early 1900’s, medical providers have been interested in patient outcomes.  After all, their efforts are only worthwhile if they actually work.  So, physicians began developing standards by which they could measure the efficacy of certain medical treatments.  The first standards were set by the American College of Surgeons which began the practice of hospital inspections.  At that time, standards were only a page long.

With the formation of the Joint Commission on Accreditation of Hospitals in 1951, standards for medical care became much longer and more rigorous.  As the number of hospitals increased and inspection programs expanded, the Joint Commission decided change was necessary to better track hospital data, quality and outcomes.  In 1999, along with the Centers for Medicare & Medicaid Services (CMS), they created what are now known as core measures.

What Are Core Measures?

Core measures are a variety of evidence-based, scientifically-researched standards of care that are shown to improve clinical outcomes for patients.  They are guidelines hospitals are encouraged and incentivized to follow with the goal of improving patient safety and care.  They set the standard of care for patients with specific medical conditions.  For example, patients undergoing certain surgical procedures are at high risk for DVT (deep vein thrombosis).  Core measures state that these patients must be placed on blood thinning medications or treated with mechanical prevention to reduce DVT risk.

Core measure data is collected by hospitals and healthcare companies delivering patient care and reported to CMS.  This data is reported as a percentage of patients who receive a recommended care measure.  Currently, there are more than 30 core measures organized into multiple categories.

Do All Patients Fall Under Core Measure Standards?

The stated goal of CMS is to “do the greatest good possible for the most people”.  While core measure standards are the best treatment for most patients, sometimes core measures contradict what is best for the patient.  It’s impossible to create standard guidelines that are best for everyone.  For example, if a patient presents to the emergency department with acute myocardial infarction, core measures indicate the patient should be given aspirin.  The provider, however should not administer aspirin if the patient has an allergy to this medication.

In these types of cases, it is important to document why the core measure was not followed.  This way, when reporting to CMS the hospital is able to identify why the patient fell outside of core measure standards.  These patients will not be factored into core measure compliance scores.

Categories of Core Measures

Core measure categories include: venous thromboembolism, heart failure, emergency department, surgical care improvement, substance abuse, tobacco treatment, pneumonia measures, immunization, acute myocardial infarction, children’s asthma care, hospital-based inpatient psychiatric services, perinatal care, stroke and hospital outpatient department.

These categories were chosen as CMS has identified them as health areas affecting large numbers of people.  Therefore, they believe these areas have the most potential to make an impact on a large number of patients.  For example, congestive heart failure (CHF) accounts for 700,000 hospitalizations each year.  Core measure guidelines recommend that CHF patients in the hospital be placed on a trial of an ACE inhibitor and receive smoking cessation counseling.  CMS hopes these measures will prevent worsening disease and future hospitalizations for a number of these 700,000 patients.

What Do CMS and the Joint Commission Do With Core Measure Data?

CMS receives core measure data on a quarterly basis then reports it to the public.  By publicly reporting data, CMS hopes high quality hospitals will be rewarded while patients will avoid seeking treatment at hospitals with lower standards of care.

Beginning in 2014, they plan to begin using this data to track hospital billing practices as well.  This new measure will track Medicare spending per beneficiary including pre and post-hospital admission charges comparing the costs of different healthcare facilities.  In order to avoid penalties from the Joint Commission, all health care organizations must report core measure data.

Why Does Your Employer Care if You Comply?

The amount your hospital is paid by Medicare depends on compliance with core measures.  Facilities maintaining higher percentages of compliance with core measures are reimbursed at higher rates by Medicare.  Naturally, your employer wants to maximize revenue.

Overall, core measure data can make your job as a medical provider a bit tedious.  Like all rules and regulations, core measures create more cumbersome paperwork and pressure to perform from administration.  Despite the inconvenience, it is important that you are aware of core measures affecting your area of practice.  Your awareness of these guidelines and compliance with them will make you stand out above other providers in your practice.  Compliance with core measures helps ensure the welfare of your patients as well as to maintain your hospital’s public image.  So, even if just hearing the words “core measure” makes you want to cringe, it’s in your best interest to comply.

Is your employer pushing core measure compliance this year?  How has it affected your job as a nurse, nurse practitioner or physician assistant?