HCQM - Quality Improvement,
Management, & Assurance UPDATED
ACTUAL Questions and CORRECT
Answers
1993's Quality Assurance Reform Initiative (QARI) - CORRECT ANSWER - Assists
states in the development of continuous quality improvement systems, internal and external
quality assurance programs, and focused clinical studies. Provides a general approach for state
Medicaid agencies to follow, but does not offer specific tools or methodologies.
1996's Quality Improvement System for Managed Care (QISMC) - CORRECT
ANSWER - CMS developed this to act as a guide to quality management oversight for
federal and state health care purchasers and is required of all health plans participating in
Medicare and is a voluntary guide for state Medicaid programs.
1997's Balanced Budget Act (BBA) - CORRECT ANSWER - Included new provisions for
Quality Assessment and Performance Improvement and a comprehensive revision of federal
statutes governing Medicaid managed care.
2 factors to be considered when designing an outcomes measure. - CORRECT ANSWER -
Direct causality and efficiency
2 Process focused models - CORRECT ANSWER - Lean and Six Sigma
2002's Quality Improvement Organization (QIO) - CORRECT ANSWER - PROs became
QIOs which better describe their proactive role in improving health care. CMS issued a final rule
to implement BBA provisions relating to how quality measurement and performance
improvement programs should be applied the Medicaid Managed Care. These provisions updated
the approach outlined in QISMC and specified that the programs develop and implement a
comprehensive quality assessment and improvement process in both clinical and nonclinical
areas and that states conduct an annual external quality review of MMC organizations.
,2006's Physician Quality Reporting Initiative (PQRI) - CORRECT ANSWER -
Established by Tax Relief and Health Care Act of 2006 (TRHCA) and authorized the
implementation of physician quality reporting system that establishes a financial incentive for
eligible professionals who participate in voluntary quality reporting programs.
3 core functions of QIOs - CORRECT ANSWER - 1. Improving quality of care 2.
Protecting the integrity of the Medicare Trust Fund by ensuring that Medicare pays only for
services and goods that are reasonable and necessary and that are provided in the most
appropriate setting 3. Protecting beneficiaries by expeditiously addressing individual complaints
such as beneficiary complaints, provider based notice appeals, violations of the Emergency
Medical Treatment and Labor Act (EMTALA), and other related responsibilities as articulated in
QIO related law.
4 Goals of Quality Improvement System for Managed Care - CORRECT ANSWER - to
establish objective and measurable standards to improve the health of Medicare/Medicaid
beneficiaries. 1. Clarify the responsibilities of CMS and the states in promoting quality as value-
based purchasers of services for vulnerable populations 2. Promote opportunities for partnership
between CMS and the states and other public and private entities involved n quality
improvement efforts. 3. Develop coordinated Medicare and Medicaid quality oversight system to
reduce duplicate or conflicting efforts and send a uniform message on quality to organizations
and consumers. 4. To make effective use of quality measurement and improvement tools while
allowing sufficient flexibility to incorporate new developments.
4 steps of an Effective Process Improvement Process - CORRECT ANSWER - 1. Find an
opportunity to improve 2. Assess the opportunity 3. Act on an opportunity 4. Measure results
5 Basic steps of Stanley Campbell, Research Design - CORRECT ANSWER - 1. Establish
definitions, procedures, and scripts to be followed so that there is reproducibility among data
collection processes and assure data integrity. 2. Get baseline or pre-test measurement (T1) 3.
Apply the treatment for a pre-selected amount of time (X). 4. Measure again (T2). 5. Determine
the statistical significance between T1 and T2.
A root cause analysis is considered incomplete if it does not include this type of assessment. -
CORRECT ANSWER - Cultural.
, A root cause analysis should always include an analysis of these types of issues which include
prevailing attitudes or frequently held assumptions. - CORRECT ANSWER - Cultural
issues
Abraham Flexner - CORRECT ANSWER - Quality should be measured.
According to Juran, when many factors influence a system - CORRECT ANSWER - Only
a vital few factors will significantly change the system.
Addressing these will have the most impact on patient outcomes. - CORRECT ANSWER -
Common causes.
Agency administering the PRO/QIO program - CORRECT ANSWER - CMS
Analyzes areas in which an organization or provider may lose money in order to identify
opportunities for improvement. - CORRECT ANSWER - Risk Mangement
Audits done by this type of reviewer are the least reliable. - CORRECT ANSWER - Single
reviewer.
Avendis Donabedian, MD - CORRECT ANSWER - Brought modern quality assurance
techniques to modern medicine by emphasizing structure, process, and outcome.
Balanced Budget Act of 1997 - CORRECT ANSWER - Rules used to form current QIOs
Basic common threads of Quality Management. - CORRECT ANSWER - Examine the
processes leading to the delivery of care, the outcomes expected from the care, and the degree to
which the expected outcomes are reached.
Management, & Assurance UPDATED
ACTUAL Questions and CORRECT
Answers
1993's Quality Assurance Reform Initiative (QARI) - CORRECT ANSWER - Assists
states in the development of continuous quality improvement systems, internal and external
quality assurance programs, and focused clinical studies. Provides a general approach for state
Medicaid agencies to follow, but does not offer specific tools or methodologies.
1996's Quality Improvement System for Managed Care (QISMC) - CORRECT
ANSWER - CMS developed this to act as a guide to quality management oversight for
federal and state health care purchasers and is required of all health plans participating in
Medicare and is a voluntary guide for state Medicaid programs.
1997's Balanced Budget Act (BBA) - CORRECT ANSWER - Included new provisions for
Quality Assessment and Performance Improvement and a comprehensive revision of federal
statutes governing Medicaid managed care.
2 factors to be considered when designing an outcomes measure. - CORRECT ANSWER -
Direct causality and efficiency
2 Process focused models - CORRECT ANSWER - Lean and Six Sigma
2002's Quality Improvement Organization (QIO) - CORRECT ANSWER - PROs became
QIOs which better describe their proactive role in improving health care. CMS issued a final rule
to implement BBA provisions relating to how quality measurement and performance
improvement programs should be applied the Medicaid Managed Care. These provisions updated
the approach outlined in QISMC and specified that the programs develop and implement a
comprehensive quality assessment and improvement process in both clinical and nonclinical
areas and that states conduct an annual external quality review of MMC organizations.
,2006's Physician Quality Reporting Initiative (PQRI) - CORRECT ANSWER -
Established by Tax Relief and Health Care Act of 2006 (TRHCA) and authorized the
implementation of physician quality reporting system that establishes a financial incentive for
eligible professionals who participate in voluntary quality reporting programs.
3 core functions of QIOs - CORRECT ANSWER - 1. Improving quality of care 2.
Protecting the integrity of the Medicare Trust Fund by ensuring that Medicare pays only for
services and goods that are reasonable and necessary and that are provided in the most
appropriate setting 3. Protecting beneficiaries by expeditiously addressing individual complaints
such as beneficiary complaints, provider based notice appeals, violations of the Emergency
Medical Treatment and Labor Act (EMTALA), and other related responsibilities as articulated in
QIO related law.
4 Goals of Quality Improvement System for Managed Care - CORRECT ANSWER - to
establish objective and measurable standards to improve the health of Medicare/Medicaid
beneficiaries. 1. Clarify the responsibilities of CMS and the states in promoting quality as value-
based purchasers of services for vulnerable populations 2. Promote opportunities for partnership
between CMS and the states and other public and private entities involved n quality
improvement efforts. 3. Develop coordinated Medicare and Medicaid quality oversight system to
reduce duplicate or conflicting efforts and send a uniform message on quality to organizations
and consumers. 4. To make effective use of quality measurement and improvement tools while
allowing sufficient flexibility to incorporate new developments.
4 steps of an Effective Process Improvement Process - CORRECT ANSWER - 1. Find an
opportunity to improve 2. Assess the opportunity 3. Act on an opportunity 4. Measure results
5 Basic steps of Stanley Campbell, Research Design - CORRECT ANSWER - 1. Establish
definitions, procedures, and scripts to be followed so that there is reproducibility among data
collection processes and assure data integrity. 2. Get baseline or pre-test measurement (T1) 3.
Apply the treatment for a pre-selected amount of time (X). 4. Measure again (T2). 5. Determine
the statistical significance between T1 and T2.
A root cause analysis is considered incomplete if it does not include this type of assessment. -
CORRECT ANSWER - Cultural.
, A root cause analysis should always include an analysis of these types of issues which include
prevailing attitudes or frequently held assumptions. - CORRECT ANSWER - Cultural
issues
Abraham Flexner - CORRECT ANSWER - Quality should be measured.
According to Juran, when many factors influence a system - CORRECT ANSWER - Only
a vital few factors will significantly change the system.
Addressing these will have the most impact on patient outcomes. - CORRECT ANSWER -
Common causes.
Agency administering the PRO/QIO program - CORRECT ANSWER - CMS
Analyzes areas in which an organization or provider may lose money in order to identify
opportunities for improvement. - CORRECT ANSWER - Risk Mangement
Audits done by this type of reviewer are the least reliable. - CORRECT ANSWER - Single
reviewer.
Avendis Donabedian, MD - CORRECT ANSWER - Brought modern quality assurance
techniques to modern medicine by emphasizing structure, process, and outcome.
Balanced Budget Act of 1997 - CORRECT ANSWER - Rules used to form current QIOs
Basic common threads of Quality Management. - CORRECT ANSWER - Examine the
processes leading to the delivery of care, the outcomes expected from the care, and the degree to
which the expected outcomes are reached.
