including the Center for Medicare and Medicaid Innovation and the Center for Dual Eligibles. CMS manages the Consumer Assessment of Healthcare Providers and Systems (CAHPS) for the MIPS. One of its newer initiatives, Patients over Paperwork, has looked to reduce the paperwork burden for providers while continuing to monitor for quality. CMS itself takes on great importance in the quality arena more broadly. The 2020 CMS quality conference drew over 3,500 attendees from across the country, and showcased the increasing involvement of CMS staff and contractors in quality measurement data analysis and reporting, and in engaging with the Meaningful Measures Initiative, the QIO 12th Scope of Work, and other efforts to embrace quality.
In approximately 2010, CMS, at the request of ANA leadership, created a Nursing Steering Committee that includes several CMS officials who are nurses, willing to address concerns that arise from external nursing organizations about Medicare and Medicaid reimbursement, service issues for Medicare or Medicaid recipients, and quality and safety issues. This Steering Committee includes a number of nursing organizations and continues to meet quarterly by conference call, addressing problems, new CMS initiatives, proposed rules, and most recently efforts to address the concerns of nurses in the field with regard to the COVID‐19 pandemic.
One of the key supportive features of CMS during the pandemic was its commitment to providing multiple weekly stakeholder calls to support the various health care workforce‐related issues that surfaced. Weekly nursing stakeholder calls were reported to be well attended, and CMS staff reached out to nurse leaders to provide advice to the front lines and hear their concerns during these calls, focused on addressing safety and quality of care.
CMS staff and leadership, in response to COVID‐19 and related emergency declarations, took steps to prepare and implement emergency rules. Several of these impacted nurses and APRNs. Scope of practice restrictions were lifted, depending upon the statutes in each state. Nurses who were willing to travel out of state to assist others in dealing with COVID‐19 workforce shortages had barriers such as licensure in another state lifted. Providers including APRNs, depending on scope of practice, were allowed to provide and bill for telehealth visits.
As policy efforts have shifted from passage of the ACA to defining the rules and regulations that impact implementation of its many provisions, the CMS Nursing Steering Committee continues to be extremely valuable in identifying opportunities for the profession to weigh in with public comment on proposed rules, and in calling to attention and advocating for changes to language that would disadvantage nursing practice or reduce nursing’s ability to keep patients safe. It continues to serve as a welcome venue for getting timely information about CMS initiatives that potentially affect the profession and consumers.
Agency for Healthcare Research and Quality
AHRQ (www.ahrq.gov) is the lead federal agency charged with improving the quality, safety, efficiency, and effectiveness of health care for all Americans. It is one of 12 agencies within the HHS. AHRQ supports research that helps people make more informed decisions and improves the quality of health care services. It is committed to improving care safety and quality, and does this through successful partnerships and the development of knowledge and tools needed for long‐term improvement. AHRQ’s research goals include measurable improvements in health care, with a focus on improved quality of life, improved patient safety and outcomes, and high‐value care for each dollar spent. AHRQ’s Patient Safety Network (PSNet) highlights journal publications, books, and tools related to patient safety. It had developed tool kits and, until funding from Congress was cut, hosted national clearinghouse services related to care guidelines and quality measures.
Standard Setting by Nonfederal Agencies
Accreditation bodies such as the Joint Commission, the National Commission on Quality Assurance, the Utilization Review Accreditation Commission, and other CMS‐deemed entities impact how quality is recognized and monitored in practice settings. They drive quality through formal policy mechanisms of setting, monitoring, and evaluating accreditation standards and recognition criteria. Although accreditation is voluntary and paid for by the institution seeking it, accreditation processes wield a great deal of power in shaping expectations of quality and safety. To ensure the reasonableness of standards and evaluation criteria, professional organizations and alliances participate in the development and revision of accreditation and recognition criteria and measures. ANA and others seek to ensure that nurses provide board representation, public comments, or advocacy efforts as checks and balances on the rigor of the accreditation standards and recognition criteria these entities use as the yardstick by which performance is evaluated.
Joint Commission
While the Joint Commission as we know it is almost 70 years old, its history goes back to 1910. It is an independent, nonprofit organization that, through its deemed status from CMS, accredits and certifies more than 19,000 health care organizations and programs in the United States, including acute care and long‐term care facilities, ambulatory care services, hospice and home care programs, behavioral health programs, managed care entities, and health care staffing services. The Joint Commission states that these activities are undertaken to continuously improve the safety and quality of care provided to the public. The Joint Commission uses Professional‐Technical Advisory Committees to establish or modify existing standards and determine patient safety goals. Nursing input into these activities occurs through multiple professional nursing organizations with representation on the various advisory and professional‐technical committees, through ongoing dialogues, and via a separately established Nursing Advisory Council that meets periodically to consider nursing issues where the Joint Commission standards play a role in shaping policy. The Joint Commission has had at least one board seat held by a nurse.
National Committee for Quality Assurance
Founded in 1990, the National Committee for Quality Assurance (NCQA; http://ncqa.org) is a private, nonprofit organization dedicated to improving health care quality and elevating health care quality to the top of the national agenda. NCQA is governed by an independent board composed of multiple stakeholder groups and has deemed status from CMS. NCQA develops quality standards and performance measures for a broad range of health care entities. These standards and measure are the tools that organizations and individuals can use to identify opportunities for improvement. Annual reporting of performance against such measures provides direction for improvement. NCQA collects Healthcare Effectiveness Data and Information Set data, known as HEDIS (Health Plan Employer Data and Information Set Measures), from more than 700 health plans; conducts accreditation, certification, and state plan surveys; and develops and conducts formal recognition programs, including the Primary Care Medical Home Recognition Program. No nursing organizations are included in the governance of NCQA, although nurses have been in key positions at one time or another. However, nursing organizations have actively engaged with NCQA to urge acceptance of APRNs as leaders of medical homes, so that several nurse‐led medical homes are now recognized by NCQA’s programs. Nurse faculty and others have worked with NCQA to mine relevant data regarding APRN practice and the outcomes of patients receiving care by APRNs in practice settings.
Utilization Review Accreditation Commission
The Utilization Review Accreditation Commission (URAC; www.urac.org),
initiated in 1990, is a nonprofit organization promoting health care quality by accrediting health care organizations, developing measurement, and providing education. URAC’s mission is to protect and empower the consumer. Its first mission was to improve the quality and accountability of utilization review programs. Its spectrum of
