Quality Measures
What are Quality Measures?
- Quality measures are defined by the Centers for Medicare & Medicaid Services (CMS) as tools that help us measure or quantify healthcare processes, outcomes, patient perceptions, and organizational structure and/or systems that are associated with the ability to provide high-quality health care (Centers for Medicare & Medicaid Services, 2023).
- Quality measures look at how a system, facility, or payer is performing in relation to others in the healthcare system. These measures are also used by payers to adjust payments based on performance and/or reporting.
Basics of Quality Measures
For information about how measures are structured, and types of measures, download a copy of the National Quality Forum (NQF) Infographic, via the following link Understanding Performance Measures: Anatomy and Types
Quality Measures Across the Lifespan
Medicare and Care Compare
Quality measures are used for all ages and health plans. CMS, the largest payer of occupational therapy services, has been the industry leader with their use of quality measures in the Medicare programs covering acute, post-acute care, and outpatient. Access public data on Medicare quality performance at the Care Compare link above.
Children's Health Care Quality Measures
Quality measures cover clients across the lifespan. Beginning in 2024, states are required to report on the Child Core Set of quality measures. These measures are meant to strengthen the quality of care and health outcomes of children in the Medicaid and Children's Health Insurance Program (CHIP). Learn more about the Children's Health Care Quality Measures in the link above.
Identify and Advocate
Use AOTA's resources to identify evidence-based interventions and advocate for occupational therapy's value in addressing common areas of quality measurement. The areas listed below are not all inclusive, there could be more depending on the health plan and setting.
Additional Articles and Books
Expand your knowledge with the latest research, perspectives, and solutions from occupational therapy practitioners.
References
CMS (2023, October). New to Measures. https://mmshub.cms.gov/about-quality/new-to-measures/what-is-a-measure
CMS (2022, April). Quality Measures. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityMeasures
National Quality Forum (2013). Understanding Performance Measures: Anatomy and Types. https://www.qualityforum.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=80285
Occupational Therapy Practice Framework: Domain and Process—Fourth Edition. Am J Occup Ther August 2020, Vol. 74(Supplement_2), 7412410010p1–7412410010p87. doi: https://doi.org/10.5014/ajot.2020.74S2001