In 1980, Jimmy Carter established the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research as an effort to study the differences in availability of health services in the United States. In 1983, the Commission issued a report called Securing Access to Health Care, which aimed to provide an ethical framework for the evaluation of health policy in the United States.¹ From this initiative, and from examples in other countries, came hospital ethics committees (HECs). These committees, which deal with the moral and ethical aspects of medical practice, were designed originally to provide legal protection for medical personnel and hospitals, but have varying and diverse goals depending on the institution.² They differ from clinical research review boards, human subjects review committees and institutional review boards (IRBs) in that these other groups evaluate ethics of medical research, while HECs evaluate ethics of medical practice.

According to the American Medical Association (AMA), HECs serve to make recommendations about difficult, life-changing situations in the lives of patients, families, physicians and other health care professionals.³ In addition, many ethics committees facilitate ethics-related education and policy changes within their institutions.³ The AMA holds that HECs should adhere to the following guidelines: serve as advisors and educators rather than decision-makers, respect the rights and privacy of all participants and of committee deliberations, ensure that stakeholders have timely access to services, be structured appropriately to fit the institution and its patients, adopt and adhere to institutional policies and draw on resources of professional organizations.³ Other sources claim that ethics committees should approach ethical dilemmas with both code consistency—i.e., adhering to the rules and guidelines of the committee and hospital—and ethical consistency—i.e., suggesting decisions that are ethically acceptable.⁴ Clearly, HECs are held to high standards and strict guidelines by the AMA, as well as by individual researchers.

As they perform ethical consultations, develop institutional policy and educate health professionals, HECs face various challenges. For one, they must protect the interests of individual patients and broader institutions while remaining unbiased and independent.⁵ Also, HECs must convince health professionals to engage patients and their families in ethical decisions, such as engagement of the “do not resuscitate” policy.⁶ A third barrier for HECs is educating health professions students on the gravity of the decisions they make and the ethical dilemmas they may face throughout their careers.⁶ HECs may face backlash by students, professionals, patients and institutions for every recommendation they make.

Indeed, controversy exists about the effectiveness of HECs. Some claim that ethics committees undermine the trust established between a patient and a physician, as HECs imply that ethical decisions are too complex for practitioners and must be approached by a group.⁷ On the other hand, one study found that mental health professionals find HECs useful in dilemmas related to coercion, confidentiality, information and patient autonomy.⁸ Other health professionals see the value in HECs as means to avoid legal conflicts with patients and families.⁹ Overall, research on the effectiveness of HECs is lacking, and it remains unclear if HECs lead to better patient care.^10,11

In sum, HECs represent the move of the medical community from a scientific approach to a social one.² HECs, which adhere to policies laid out by national organizations and local institutions, aim to bring objectivity and ethical reasoning to life-changing dilemmas and to educate professionals on ethical decision-making. Future research is needed to understand health professionals’ relationships with HECs and to clarify the usefulness of HECs in improving patient care.

 

1. Bayer R. Ethics, politics, and access to health care: A critical analysis of the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. Cardozo Law Review. 1984;6(2):303–320.
2. Rosner F. Hospital medical ethics committees: A review of their development. JAMA. 1985;253(18):2693–2697.
3. American Medical Association. Ethics Committees in Health Care Institutions: Code of Medical Ethics Opinion 10.7. AMA Principles of Medical Ethics: II, IV, VII 2019; https://www.ama-assn.org/delivering-care/ethics/ethics-committees-health-care-institutions.
4. Moore A, Donnelly A. The job of ‘ethics committees’. Journal of Medical Ethics. 2018;44(7):481–487.
5. Dörries A, Boitte P, Borovecki A, Cobbaut J-P, Reiter-Theil S, Slowther A-M. Institutional Challenges for Clinical Ethics Committees. HEC Forum. 2011;23(3):193.
6. Hajibabaee F, Joolaee S, Cheraghi MA, Salari P, Rodney P. Hospital/clinical ethics committees’ notion: An overview. Journal of Medical Ethics and History of Medicine. 2016;9:17.
7. Siegler M. Ethics Committees: Decisions by Bureaucracy. The Hastings Center Report. 1986;16(3):22–24.
8. Syse I, Førde R, Pedersen R. Clinical ethics committees – also for mental health care? The Norwegian experience. Clinical Ethics. 2016;11(2–3):81–86.
9. Marcus BS, Shank G, Carlson JN, Venkat A. Qualitative Analysis of Healthcare Professionals’ Viewpoints on the Role of Ethics Committees and Hospitals in the Resolution of Clinical Ethical Dilemmas. HEC Forum. 2015;27(1):11–34.
10. Hem MH, Pedersen R, Norvoll R, Molewijk B. Evaluating clinical ethics support in mental healthcare: A systematic literature review. Nursing Ethics. 2014;22(4):452–466.
11. Harari DY, Macauley RC. The Effectiveness of Standardized Patient Simulation in Training Hospital Ethics Committees. The Journal of Clinical Ethics. 2016;27(1):14–20.

The Society for Ambulatory Anesthesia (SAMBA) strives to be the leader in perioperative—i.e., before and after surgery—of the ambulatory surgical patient.¹ Ambulatory anesthesia is used for ambulatory surgery, which is a surgical procedure where the patient does not need to stay overnight in a hospital (outpatient, office-based and non-operating room procedures), and it includes general, regional, local and sedation anesthetics.² Tens of millions of ambulatory surgery procedures, including endoscopy and cataract surgery, are performed per year,³ and the number and variety of procedures are rapidly growing.² Because of the rising popularity of ambulatory surgery, ambulatory anesthesia and SAMBA are important factors in today’s medical system. According to SAMBA, its goals are to advance the practice of ambulatory anesthesia, to promote high ethical and professional standards, to provide professional guidance for the practice of perioperative care of ambulatory surgical patients and to foster and encourage education and research.¹ Its officers are medical doctors,⁴ while its board of directors includes lawyers, medical doctors and businesspeople.⁵ Members can include physicians, scientists, teachers, non-physician providers of ambulatory anesthesia care, anesthesiology residents and honorary contributors.⁶ Overall, SAMBA represents a diverse group of professionals who aim to improve and learn about the quickly growing field of ambulatory anesthesia.

Given SAMBA’s missions to educate physicians and patients about ambulatory anesthesiology and to provide guidance to ambulatory anesthesia providers,⁷ SAMBA provides its members with events, meetings, fellowships, webinars, research awards and other opportunities.⁸ Its fellowship curriculum, developed by the Fellowship Taskforce for the SAMBA Ambulatory Anesthesiology Fellowship Program and approved by the SAMBA board in October 2009, aims to provide trainees with competencies ranging from patient care to medical knowledge, as well as skills in surgeries from ophthalmologic to pediatric procedures.⁹ Also, SAMBA hosts a several-day meeting every year¹⁰—in fact, SAMBA itself was formally established at a 1985 meeting of the American Society of Anesthesiologists (ASA).¹¹ Meeting lectures include sessions on obstructive sleep apnea, dealing with an active shooter in an ambulatory surgery center (ASC), preparing for disasters and ceasing the prescription of opioids, and are led by practitioners, directors of ASCs, ASA and industry leaders and more.¹⁰ Clearly, SAMBA focuses on educating and providing opportunities for professionals to further the improvement of ambulatory anesthesiology.

In addition to providing educational and professional development opportunities, SAMBA establishes standards for safe practices. For example, a multidisciplinary committee of SAMBA compiled guidelines for the management of postoperative nausea and vomiting (PONV) for all ambulatory anesthesiology workers,¹² and more recently for perianesthesia nurses specifically.¹³ Another systematic literature review by SAMBA established consensus on perioperative blood glucose management in diabetic patients undergoing ambulatory surgery.¹⁴ By using scientific evidence to establish best practices, SAMBA illustrates standardized work, which is a quality improvement tool that serves as the current best way to safely achieve the best patient outcomes.¹⁵ The development of protocols and guidelines has been controversial in that many physicians consider standardization harmful to many vital aspects of medicine^16,17; however, evidence-based practice has been widely popularized in the past 20 years¹⁸ and allows health professionals to combine systematic research with their own experiences.¹⁹ In short, SAMBA continues to adopt contemporary medical strategies by integrating evidence-based guidelines into ambulatory anesthesia.

Today, with 70 to 80 percent of surgeries performed on a day-surgery basis nationally, SAMBA focuses on advancing ambulatory anesthesiology, measuring outcomes and developing evidence-based standards, specifically emphasizing education and research.²⁰ SAMBA provides learning and improvement opportunities to its members and establishes standardized practices based on scientific evidence. Going forward, SAMBA will need to stay apace with the rapidly changing specialty of ambulatory anesthesiology, while also investigating if its guidelines fit patients’ and physicians’ needs.

1.         Society for Ambulatory Anesthesia. About Us. 2019; https://sambahq.org/about-us/.

2.         UC Davis Health. Ambulatory anesthesia. 2019; https://health.ucdavis.edu/anesthesiology/specialties/ambulatory.html.

3.         Cullen KA, Hall MJ, Golosinskiy A. Ambulatory surgery in the United States, 2006. 2009.

4.         Society for Ambulatory Anesthesia. Officers. 2019; https://sambahq.org/about-us/officers/.

5.         Society for Ambulatory Anesthesia. Board of Directors. 2019; https://sambahq.org/about-us/board-of-directors/.

6.         Society for Ambulatory Anesthesia. Membership Categories. 2019; https://sambahq.org/membership/membership-categories/.

7.         Walsh MT. SAMBA–Building for the Future of Ambulatory Anesthesia. ASA Newsletter. 2017;81(2):56–57.

8.         Society for Ambulatory Anesthesia. SAMBA. 2019; https://sambahq.org.

9.         Society for Ambulatory Anesthesia. Fellowship Curriculum. 2019; https://sambahq.org/education-research/fellowship-curriculum/.

10.       Society for Ambulatory Anesthesia. Annual Meeting. 2019; https://sambahq.org/meetings/2019-meeting/.

11.       Rodriguez LV, Belani KG. Society for Ambulatory Anesthesia (SAMBA) Update. ASA Newsletter. 2019;83(2):50–51.

12.       Gan TJ, Meyer TA, Apfel CC, et al. Society for Ambulatory Anesthesia Guidelines for the Management of Postoperative Nausea and Vomiting. Anesthesia & Analgesia. 2007;105(6):1615–1628.

13.       Hooper VD. SAMBA Consensus Guidelines for the Management of Postoperative Nausea and Vomiting: An Executive Summary for Perianesthesia Nurses. Journal of PeriAnesthesia Nursing. 2015;30(5):377–382.

14.       Joshi GP, Chung F, Vann MA, et al. Society for Ambulatory Anesthesia consensus statement on perioperative blood glucose management in diabetic patients undergoing ambulatory surgery. Anesthesia and Analgesia. 2010;111(6):1378–1387.

15.       Jankowski CJ, Walsh MT. Quality Improvement in Ambulatory Anesthesia: Making Changes that Work for You. Anesthesiology Clinics. 2019;37(2):349–360.

16.       Hung D, Martinez M, Yakir M, Gray C. Implementing a Lean Management System in Primary Care: Facilitators and Barriers From the Front Lines. Quality Management in Health Care. 2015;24(3):103–108.

17.       Hartzband P, Groopman J. Medical Taylorism. New England Journal of Medicine. 2016;374(2):106–108.

18.       Guyatt G, Cairns J, Churchill D, et al. Evidence-Based Medicine: A New Approach to Teaching the Practice of Medicine. JAMA. 1992;268(17):2420–2425.

19.       Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS. Evidence based medicine: What it is and what it isn’t. BMJ. 1996;312(7023):71–72.

20.       Valedon A. The Society for Ambulatory Anesthesia in 2017: Advancing Outpatient Preoperative Care and Serving our Members. ASA Newsletter. 2018;82(2):60–63.

The Healthcare Effectiveness Data and Information Set (HEDIS) is a set of standardized performance measures that allows consumers and purchasers to reliably compare health plans.¹ HEDIS was established by the National Committee for Quality Assurance (NCQA), a health care accreditor that aims to establish scientifically supported health care, to study how well health plans and doctors implement such research-based care and to identify organizations that make patient care better.² NCQA partners with the Centers for Medicare & Medicaid Services (CMS) to use HEDIS to allow Medicaid, Medicare and commercial health plans to compare their performance and quality of care with other health plans.³ Specifically, NCQA and CMS use HEDIS measures to evaluate Medicare Advantage (MA) plans, which are Medicare health plans offered by private companies including health maintenance organizations (HMOs), preferred provider organizations (PPOs), private fee-for-service plans, Special Needs Plans (SNPs) for individuals with disabling conditions and Medicare Medical Savings Account (MSA) plans.⁴ HEDIS provides a standard way to compare health care plans across the board, ranging from the various types of Medicare Advantage plans to state-wide Medicaid plans to private commercial health plans.³

According to NCQA, HEDIS includes more than 90 measures across six domains: Effectiveness of Care, Access/Availability of Care, Experience of Care, Utilization and Risk Adjusted Utilization, Health Plan Descriptive Information and Measures Collected Using Electronic Clinical Data Systems.⁵ Some examples of HEDIS measures include childhood immunization status, emergency department utilization and identification of alcohol and other drug services.⁶ For most of these measures, the percentage of plans (separated into commercial, Medicare and Medicaid) that submit data to NCQA are listed yearly on the NCQA website.^6,7 Given that more than 190 million people are enrolled in health plans that report data using HEDIS,² consumers can benefit from NCQA’s online transparency.

Due to their ubiquity, HEDIS measures can be used not only by health professionals, health plan administrators and consumers, but also by researchers. For example, a recent study by Hechter et al. used HEDIS measures of treatment initiation and engagement to compare alcohol and other drugs (AOD) use disorder in patients with or without human immunodeficiency virus (HIV).⁸ Another study by Mosen et al. compared patients who receive dental care to those who do not by using HEDIS measures.⁹ Meanwhile, Ng-Mak and Rajagopalan used HEDIS measures, such as those for cardiovascular and diabetes screening, to examine quality of care received by individuals with severe mental illness.¹⁰ Clearly, researchers use HEDIS measures to evaluate patients and their outcomes.

Nevertheless, it is unclear if HEDIS measures are accurate indicators of quality of patient care and patient outcomes. For example, Harman et al. linked a plan’s HEDIS performance to changes in enrollee health, finding that improved quality of diabetes care can result in better patient health.¹¹ However, Harris et al. found that specification validity (i.e., the ability of a measure to adequately capture care processes and patients) of HEDIS measures was excellent for records from residential and outpatient addiction programs, but more modest and highly variable across non-addiction settings.¹² Additionally, one study by Crans Yoon et al. found that compliance with the HEDIS Medication Management for people with Asthma (MMA) measure was not related to improvement in asthma outcomes.¹³ Thus, though the use of HEDIS measures in research is widespread, it remains to be seen if they can precisely or accurately depict patient outcomes in diverse settings.

Overall, HEDIS provides a standardized way for consumers, health professionals and researchers to compare performance across commercial, Medicare and Medicaid health plans. Given the popularity of HEDIS measures, future research should explore the association between compliance on HEDIS measures and real-life quality of care and patient outcomes across a variety of specialties.

1.         Centers for Medicare & Medicaid Services. Healthcare Effectiveness Data and Information Set (HEDIS). July 2017; https://www.cms.gov/Medicare/Health-Plans/SpecialNeedsPlans/SNP-HEDIS.html#targetText=NCQA%20established%20Healthcare%20Effectiveness%20Data,comparison%20of%20health%20plan%20performance.

2.         National Committee for Quality Assurance. About NCQA: Learn more about the National Committee for Quality Assurance (NCQA). 2019; https://www.ncqa.org/about-ncqa/.

3.         Beaton T. How HEDIS, CMS Star Ratings, CQMs Impact Healthcare Payers. HealthPayerIntelligence News. December 2017.

4.         Centers for Medicare & Medicaid Services. Medicare Advantage Plans. 2019; https://www.medicare.gov/sign-up-change-plans/types-of-medicare-health-plans/medicare-advantage-plans.

5.         National Committee for Quality Assurance. HEDIS and Performance Measurement. 2019; https://www.ncqa.org/hedis/.

6.         National Committee for Quality Assurance. HEDIS Measures and Technical Resources. 2019; https://www.ncqa.org/hedis/measures/.

7.         National Committee for Quality Assurance. HEDIS 2019 Data Submission Timeline. 2019; https://www.ncqa.org/hedis/data-submission/hedis-2019-data-submission-timeline/.

8.         Hechter RC, Horberg MA, Weisner C, et al. Healthcare Effectiveness Data and Information Set (HEDIS) measures of alcohol and drug treatment initiation and engagement among people living with the human immunodeficiency virus (HIV) and patients without an HIV diagnosis. Substance Abuse. 2019:1–9.

9.         Mosen D, Pihlstrom D, Snyder J, Smith N, Shuster E, Rust K. Association of Dental Care with Adherence to HEDIS Measures. The Permanente Journal. 2016;20(1):33–40.

10.       Ng-Mak D, Rajagopalan K. Examining quality of care for individuals treated for mental health using the HEDIS mental health quality measures. Current Medical Research and Opinion. 2019;35(1):87–95.

11.       Harman JS, Scholle SH, Ng JH, et al. Association of Health Plans’ Healthcare Effectiveness Data and Information Set (HEDIS) Performance With Outcomes Of Enrollees With Diabetes. Medical Care. 2010;48(3):217–223.

12.       Harris AHS, Ellerbe L, Phelps TE, et al. Examining the Specification Validity of the HEDIS Quality Measures for Substance Use Disorders. Journal of Substance Abuse Treatment. 2015;53:16–21.

13.       Crans Yoon A, Crawford W, Sheikh J, Nakahiro R, Gong A, Schatz M. The HEDIS Medication Management for People with Asthma Measure is Not Related to Improved Asthma Outcomes. The Journal of Allergy and Clinical Immunology: In Practice. 2015;3(4):547-552.

The Agency for Healthcare Research and Quality (AHRQ) was first established in 1989 in the hopes of improving the quality and efficiency of healthcare in the United States using evidence-based approaches [1]. The AHRQ contributes to improving health systems in the United States primarily by investing in research and evidence generation efforts, creating training materials and resources, and by sponsoring performance and evaluation initiatives[2]. It is important to understand the role and impact of the AHRQ when considering ways to improve one’s own clinical practice, and in making decisions about initiatives through the agency one may like to support and advocate for moving forward.

The AHRQ funds basic research in an effort to improve the safety and quality of hospital care. Some have attributed the decrease in hospital acquired infections (HACs) to the Affordable Care Act’s expanded quality and safety provisions, that are supported by the tools, resources, and data generated by the AHRQ. For instance, basic research on central line infections that was supported by the AHRQ motivated and informed the Partnership for Patients (PfP) initiatives for national education and outreach programming [2, 3]. Additionally, as part of their research initiatives, the AHRQ designed the Evidence-based Practice Center (EPC) program. The EPC program initially included 12 centers across the U.S. recruited to conduct systematic reviews of the evidence available on important questions in healthcare. These questions were nominated by leaders in the medical field who would later be tasked with utilizing the results of these studies to improve clinical practices. There are now 13 centers, the majority of which are generalist EPCs that review a wide range of topics decided by outside partners [1].

The AHRQ plays an important role in nurturing system-wide change by reshaping, restructuring, supporting and supplementing provider training. TeamSTEPPS, for instance, is an evidence-based set of teamwork tools that is available on the AHRQ website aimed at improving communication and collaboration skills between health care professionals, making study evidence applicable and usable in direct patient practice [4]. One of the essential resources they have made available is the AHRQ Guideline Clearing House, which lost it’s funding and has since shut down in 2018 [5]. The Guideline Clearing House was a comprehensive national clinical guideline resource created in 1998, which summarized over 10,000 clinical practice guidelines over its lifetime. The Clearing House was born from a clinical guidelines program established by AHRQ between 1990 and 1996, which received pushback from specialists who interpreted the guidelines as an attempt to limit expensive procedures as well as a large contingency of professionals who wanted to limit government involvement in clinical policy [1].

Data resources, reports, and national surveys provided by AHRQ are essential information pools for researchers, providers, and policy makers. Important data projects on patient experience and quality improvement have been spearheaded by AHRQ. This includes the largest family of databases on hospital care in the United States under The Healthcare Cost and Utilization Project as well as The Medical Expenditure Panel Survey, which is the most complete dataset on healthcare costs and insurance in the U.S [2].

Incredible work has been done by the AHRQ to create evidence-based standards and guidelines across the United States for improving the quality of healthcare while also investing efforts into creating training resources and access to national data and important population-level information. As with any agency with high hopes of changing and improving systems to safely and effectively treat all patients with the same quality standard of care, the AHRQ still has much to strive for. Early criticism of AHRQ guidelines highlighted the slow and expensive process of developing such guidelines, as well as the need for further adaptation of guidelines for local practices due to the challenge of creating standardized guidelines that consider and include all possible scenarios. The agency continues to investigate new ways to improve practices outside of the hospital, wherever patients need and receive care through grants that support opioid use reduction in rural areas, as well as community health physician training programs in New Mexico [2, 6, 7]. Moving forward, it is the hope that AHRQ will continue to improve their processes to make information more accessible to patients, policy makers, physicians, and researchers in a timely manner, and to find innovative ways to make better healthcare decisions using evidence-based approaches. 

References

1.         David Atkins, K.F., Jean Slutsky, Better Information for Better Health Care: The Evidence-based Practice Center Program and the Agency for Healthcare Research and Quality Annals of Internal Medicine, 2005. 142(12): p. 1035-1041.

2.         Kronick, R., AHRQ’s Role in Improving Quality, Safety, and Health System Performance. Public Health Reports, 2016. 131(2): p. 229-232.

3.         Department of Health and Human Services (US), Office of the Assistant Secretary for

Planning and Evaluation, Saving lives and saving money: hospital-acquired conditions

update. 2015.

4.         Department of Health and Human Services (US), Office of the Assistant Secretary for

Planning and Evaluation, TeamSTEPPS®: Strategies and Tools to Enhance Performance

and Patient Safety.

5.         Physicians, A.A.o.F., AHRQ: National Guideline Clearinghouse to Shut Down July 16. 2018.

6.         Department of Health and Human Services (US), Office of the Assistant Secretary for

Planning and Evaluation, AHRQ announces grant opportunities to address opioid abuse

disorder in rural areas.

7.         Department of Health and Human Services (US), Office of the Assistant Secretary for

Planning and Evaluation. Project ECHO: Extension for Community Healthcare Outcomes

(New Mexico) Available from: https://healthit.ahrq.gov/ahrq-funded-projects/project-echo-extension-community-healthcare-outcomes.

The Quality Payment Program, also referred to as the QPP, is a program implemented by the Department of Health and Human Services through the Centers for Medicare and Medicaid Services (CMS). In brief, the QPP is a reimbursement mechanism that is designed to place a high value, and hence reimbursement, on physicians that are delivering high-quality care, while separating these from physicians who are not meeting national or specific standards of quality of care. The QPP is a program in multiple parts, including data collection, summarization, feedback generation, and finally, calculation of payment^[1]. Not only is the QPP a means of ascertaining the financial reimbursement for physicians serving Medicare-insured populations, but also, it is a mechanism by which physicians can be included in the decision-making process. Launched in 2017, the QPP is currently now in its second year of program participation across the United States, with preliminary results promising.

Before a discussion of the current state of the QPP, it is important to understand how exactly the program functions. To participate in the program, physician practices must agree to meet extensive data collection objectives. In line with this, the QPP urges practices to demonstrate how technology, specifically advanced technology, has aided with the collection and generation of data. The next step requires practices to send in summarization reports of collected metrics to the program, under deadlines. Following this stage, CMS will conduct an analysis of your data, matching your outcomes on specific objectives to nationally recognized benchmarks in the field. CMS will then share these results with you, along with the determination of your projected reimbursement. This number may include any incentives given for above-average delivery of care. In addition, if you participate in one of the other CMS programs, for example an advanced APM, then you may be eligible for further incentives.

This is the theoretical framework of the program. However, in the last two years, how has the program functioned in practice? CMS recently released results that provide an illustration of the QPP in its second participation year^[2]. Of note, the number of eligible physicians who are electing to participate in the QPP has increased from its initial year, from 95% to 98%. The proportion of participating physicians who hail from small practices has also increased significantly, currently up to 90% of the total workforce nationwide. In addition, increasing program membership has not been linked to any decrease in reimbursement. Quite the opposite. In this program year, it is reported that 97% of participating physicians will earn a positive payment adjustment, or incentive, in 2020 as a result of meeting metrics in the program year 2018. Such results reflect CMS’ decision to align quality of care with payment and reimbursement, in a thoughtful, engaged manner.

Moving forward, the QPP continues to be a work-in-progress, shaped by the successes of years prior with attention to the areas of improvement in the past. Physicians are encouraged to be involved in the program’s development by dispersing feedback to CMS and the QPP, thus ensuring that high-quality, compassionate care is at the center of the U.S. healthcare system.

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^[1] “Quality Payment Program Overview.” QPP, Centers for Medicare and Medicaid Services, 2017, qpp.cms.gov/about/qpp-overview.

^[2] Ellison, Ayla. “CMS Releases Quality Payment Program Results: 5 Takeaways. CMS Released Preliminary Second-Year Participation Data for the Quality Payment Program on July 11.” Becker’s Hospital Review, 15 July 2019, www.beckershospitalreview.com/finance/cms-releases-quality-payment-program-results-5-takeaways.html.