Ecosysytem

Medicare is the federal health insurance program for people who are sixty-five or older, certain younger people with disabilities, and people with End-Stage Renal Disease. (CMS, 2016) In order for facilities to get Medicare funding there are some requirements they must follow. The state conducts a survey to make sure that facilities are following policies and guidelines in order to keep their Medicare certification. This process that Indiana uses is called quality indicator survey. This survey has many purposes. The purposes are to improve consistency and accuracy of quality of care and quality of life problem identification by using a more structured process, enable timely and effective feedback on survey processes for surveyors and managers, systematically review requirements and objectively investigate all triggered regulatory areas within current survey resources, provide tools for continuous improvement, enhance documentation by organizing survey findings through automation, and Focus survey resources on facilities (and areas within facilities) with the largest number of quality concerns. (in.gov, 2016) Facilities also have a non-government organization like the joint commission to evaluate the facilities. The joint commissioner can deem a facility compliant or noncompliant.

The Physician Quality Reporting System (PQRS) is a quality reporting program that encourages individual eligible professionals (EPs) and group practices to report information on the quality of care to Medicare. PQRS gives participating EPs and group practices the opportunity to assess the quality of care they provide to their patients, helping to ensure that patients get the right care at the right time. (CMS, 2016) This is like a report card in some ways. This will put a quantity of certain care given to patients to see where the professional’s specialty of care is at.

Medicare has two coverage programs. Part A coverage is hospital insurance and is financed through payroll taxes. At...