The impact of the insidious COVID-19 virus will have a long-lasting impact on the financial status and care delivery processes in hospitals across the United States. The pandemic has also underscored and emphasized the significance of clinical quality, patient and staff safety, as well as adherence to best practices for all hospitals.

On March 27, 2020, the Centers for Medicare and Medicaid Services (CMS) granted exceptions and extensions for certain deadlines to assist health care providers direct their resources toward caring for their patients and ensuring the health and safety of patients and staff. The significance of this decision is important to hospitals because of the financial implications associated with the quality metrics that influence the CMS Value-Based Purchasing (VBP) Program. Achieving or improving above baseline benchmarks not only maximizes CMS reimbursements and incentive payments through the VBP program, but quality initiatives help organizations manage overall costs by improving patient outcomes and reducing length of stay.  

Some of the quality measures driving the VBP calculations and determining reimbursement payments are hospital-acquired infection rates, patient experience scores, re-admissions, mortality and complication rates and efficiency. Although CMS granted the waiver to reduce the burden on hospitals by offering a suspension of reporting while lessening the impact of the VBP program, it did not lessen the need or expectation for hospitals to provide quality care. In fact, the COVID-19 pandemic has created an even greater need to focus on these quality measures in an effort to determine the impact of  COVID-19 on patient outcomes.  

Each and every day, healthcare providers work diligently toward the ultimate goal of saving lives and providing optimum outcomes for the patients served. It is the quality of care delivered in a safe and effective manner that influences the outcomes of patients, facilitates a safe environment for patients to receive care and staff to work, promotes efficiency and provides data and information to help identify opportunities for improvement. Therefore, a sustained focus on quality and quality measurement during times of crisis provides hospitals and other healthcare organizations data to guide and identify opportunities for improvement, and create and facilitate a stronger, safer organization.

A New Paradigm in Healthcare Delivery

Since COVID-19 has created an unanticipated and unplanned new paradigm in healthcare delivery, little time has been spent on  the changes that have occurred and how those changes are impacting care delivery across the continuum of care. Much of the change has been rooted in the efforts to combat and reduce the spread of COVID-19. The changes have placed additional demands and stressors on hospitals and healthcare providers. Reassessing and re-evaluating processes and outcomes of care delivery in light of the impact of COVID-19 has been a fluid process in response to the immediate situation at hand. As the pandemic continues to modify healthcare delivery, it is critical to determine what has been effective and promoted favorable outcomes, and what has not worked. We must continue to measure existing quality indicators and determine other quality indicators important to evaluate given the changes in care delivery processes.

Improving Patient Care Quality During the COVID-19 Crisis

Improving quality care during the COVID-19 crisis requires a back-to-the basics approach with an emphasis on continual improvement. Determining and communicating current performance levels on relevant quality measures is imperative to identify the benefits of the care delivered or where opportunities exist for improvement. Identifying new measures that will assist in determining progress toward combating and containing the spread is also important. 

Take Action  to Improve Quality

1. Communicate the measures, data and progress toward targets to all staff and providers to drive improvement and determine what is working. It does not help to confine quality discussions to the administrative suites or board rooms. 
2. Post measures, goals and progress on quality measures in break rooms and on the internet promotes staff engagement. 
3. Provide staff with a real or virtual suggestion box helps staff feel they can make a difference in the organization. Progress often occurs when informed staff and providers offer ideas for new approaches or restructuring processes. The ultimate goal is to change structure or process to improve patient outcomes.  

If the quality initiatives in the organization are implemented simply to meet regulatory requirements and the initiatives are not designed to affect patient outcomes, streamline processes or standardize care according to best practice guidelines, the initiatives may not be valued by the clinicians and thus ineffective. 

Ultimate Goal of Quality Improvement

The ultimate goal of achieving the best outcomes for the most patients while reducing cost to the patient and the organization can be achieved if the quality program is dynamic, interactive and focuses on  driving excellence by sharing information and engaging participation by everyone in the organization. 

In the final analysis, quality in healthcare should not be about reporting numbers and/or meeting metrics. It’s about changing the culture of an organization to embrace quality and safety as a foundational element of the organization which permeates the entire organization and becomes the mantra for everyone who works in the organization. The strength of a robust quality program that is responsive in crisis situations, such as the COVID-19 pandemic, provides information and data, facilitates adaptation to meet the needs of the patients and most importantly, makes a difference in the outcomes of the patients served will help maintain the stability and viability of the organization clinically and financially.