Quality, Safety, and Standards Organizations COVID-19 Impact Assessment: Lessons Learned and Compelling Needs.

Abstract

The stark reality of the COVID-19 pandemic challenged the very systems established to ensure the nation’s safety and quality. The pandemic resurfaced long-endemic challenges within the health care quality and standards ecosystem and identified novel challenges that cannot be ignored. This paper examines: 1. the health care quality and standards ecosystem pre-pandemic; 2. vulnerabilities in quality and standards organizations exposed by COVID-19; 3. quality and standards organizations’ responses during the pandemic; 4. opportunities to improve the national response to improving quality and safety overall with a particular focus on readiness in the case of disasters, pandemics, or other national emergencies; 5. sector-wide policy, regulatory, and legal changes that might be transformative; and 6. priorities moving forward. The quality and safety focus of the American health care system has a long history, dating back to the 19th and early 20th centuries. Quality of care is generally understood as providing the right care for the right person at the right time—every time. Several seminal laws and publications over the last 60 years have shaped the current quality landscape in profound ways and have been cataloged in numerous publications [1,2,3,4]. These publications generally point to several landmark occurrences that have shaped the evolution of quality measurement, improvement activities, and safety standards over the years. The evolution has centered around four main levers (see Figure 1): Open in a separate window FIGURE 1 Key Levers for Care Quality and Safety 1. survey, certification, and accreditation of facilities, laboratories, health plans, and providers; 2. quality measurement, incentives, and payment reforms; 3. public ratings of providers and facilities; and 4. quality improvement learning and action networks. Survey, Certification, and Accreditation The role of government in establishing quality and safety standards for the health care system became prominent with the implementation of the 1965 Medicare legislation, in which Congress explicitly tied payment to the achievement of minimum health and safety standards, commonly known as conditions of participation (CoPs). Initially, the CoPs focused on medical staff qualifications, nursing services, and utilization review, but have since evolved to include minimum standards for various other important safety issues, including infection control, emergency preparedness, quality assurance, performance improvement, and medication management. States also established health and safety requirements for facility licensure. State standards for health and safety must, at a minimum, align with the CoPs but may go above and beyond the federal requirements. While the state government and federal surveyors perform inspections for many facilities (primarily nursing homes), the Centers for Medicare and Medicaid Services (CMS) has approved several national accreditation organizations (AOs) to perform survey functions [5]. One of the largest AOs is the Joint Commission. Founded in 1951, the “Joint Commission accreditation can be earned by many types of health care organizations, including hospitals, doctor’s [sic] offices, nursing homes, office-based surgery centers, behavioral health treatment facilities, and providers of home care services” [65]. In 1990, the National Committee for Quality Assurance (NCQA) was established as a nonprofit organization that accredits quality programs for health plans, physicians, and other providers. NCQA developed the first set of standards for health plan quality using a set of evidence-based requirements and measurements.