The Importance of Health Care Quality
The quality of care you get from doctors and hospitals in your plan’s network matters. Learn how we make it easy to find the best care from providers near you.
Hospital Quality Measures – Process and Outcomes
The Centers for Medicare and Medicaid Services (CMS) follows a standard set of performance measures for recommended hospital care for these 5 conditions:
- Heart attack
- Heart failure
- Pneumonia
- Surgical care improvement and infection prevention
- Pediatric asthma
Hospitals are encouraged to report their quality of care information for these 5 medical conditions. Reporting is voluntary, but it’s linked to the payments hospitals get for treating Medicare patients.
Each hospital is given an overall score and detailed benchmark scores for each of the quality measures. The detailed benchmark scores include the national average hospital compliance and the top hospitals' compliance for each of the measures. (The top hospitals are the top 10% of hospitals nationwide.)
Process of care measures include quality measure sets for each of the conditions listed above.
Outcome of care measures are the 30-day rates for death and readmission to the hospital. They’re tracked for these categories:
- Heart attack
- Heart failure
- Pneumonia
HCAHPS
The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a national, standardized survey. It’s sent to a random sample of hospital patients 18 years and older within 48 hours to 6 weeks after being released from the hospital.
The survey includes 10 questions about a patients' view on important measures of care. The HCAHPS results can help you compare patients' experiences at different hospitals against state and national benchmarks.
The survey includes information about these hospital patient experiences:
- Communications with nurses and doctors
- Responsiveness of hospital staff
- Pain management
- Communication about medicines
- Discharge information
The survey also includes questions about:
- Cleanliness of the hospital environment
- Quietness of the hospital environment
- Overall rating of the hospital
- Their willingness to recommend the hospital
Blue Distinction Centers
Blue Distinction is a title given by the Blue Cross and Blue Shield companies to medical facilities that have shown expertise in delivering quality health care. The awarded title is based on strict, evidence-based selection guidelines chosen by leading medical specialists and professional organizations.
To earn this title, a facility's overall experience and total data must meet the criteria formed by expert clinicians and leading professional organizations.
Blue Distinction Centers+SM are hospitals recognized for their expertise and efficiency in providing specialty care. Quality is key: to become a Blue Distinction Center+, a facility must first meet all the quality requirements for a Blue Distinction Center before cost will be decided.