Quality measures in healthcare have gradually become a more central concern. However, there is still a ways to go before payers such as private insurers, Medicare and Medicaid and regulatory bodies such as the Centers for Medicare and Medicaid Services (CMS) evaluate providers primarily on the quality, rather than the quantity, of the services they render. That's because the traditional fee-for-service (FFS) reimbursement model remains dominant throughout the sector.
Value versus volume, and where an online healthcare MBA fits in
A 2016 assessment found that in 2013, 95% of all physician visits were reimbursed in accordance with FFS, meaning that the provider was paid based on the occurrence of a visit rather than any outcome tied to it.
Through an ongoing effort to move away from FFS and toward quality ― as embodied in the growing practice of value-based reimbursement (VBR) ― CMS and payers are hoping to create a healthcare system that produces better outcomes for patients and makes more efficient use of resources.
For example, instead of repeated visits that do not result in an effective treatment but are nevertheless reimbursed under a predictable rate, compensation would depend on the level of care provided.
Momentum has been building for VBR, resulting in significant gains from the situation in 2013. The Healthcare Payment Learning and Action Network, a part of the U.S. Department of Health and Human Services, estimated that the share of healthcare payments tied to value rose 13% from 2015 to 2017, reaching 34% ―impressive, but still behind the number tied to volume alone (41%).
As you consider pursuing a healthcare Master of Business Administration (HCMBA) degree from the George Washington University, you can choose from multiple graduate certificate options, including one in healthcare quality. Earning this certificate en route to your degree can prepare you for a rapidly changing healthcare industry in which quality and safety are coming to the forefront.
What the healthcare quality certificate covers and why you should consider it
The Graduate Certificate in Healthcare Quality is one of six certificate options from the GW School of Medicine and Health Sciences open to HCMBA students. The HCMBA itself requires completion of 55.5 credits across its core classes and healthcare-focused and general electives. The credits within each certificate may also count toward the overall elective requirements.
For the healthcare quality certificate, 18 credit hours are required, spread across the following courses:
Introduction to Healthcare Quality
This class provides an overview of current issues in healthcare quality and safety. HCMBA students will learn about the industry-wide drive toward continuous improvement and how to translate new expectations about quality into everyday operations.
Building a Quality Culture
Moving toward VBR and other quality-related initiatives requires more than just implementing different technologies or procedures. It also requires a collaborative culture. In this course, students learn how to create such an environment through the application of organizational change theories and leadership principles.
Health Care Quality Landscape
Shifts in how the healthcare sector approaches quality and safety have been driven in part by regulatory change. Legislation such as the Patient Safety and Quality Improvement Act of 2005 and the Medicare Access and CHIP Reauthorization Act of 2015 reshaped the role of quality in healthcare operations and payments. This class provides insight into both political and environmental influences on healthcare quality.
Quality Improvement Science
Quality improvement science is the field focused on systematically discovering and evaluating the most workable quality measures. This class explores quality improvement science with a look at relevant tools, models and theories.
Health Care Quality Measurement, Data Management and Analytics
Measuring any improvements in quality (or lack thereof) requires working with and understanding applicable data. This course provides the necessary background and training on how to design the right metrics and select the most useful data analysis tools.
Patient Safety Systems
Medical errors cause 250,000 deaths every year in the U.S., according to a study published in the British Medical Journal, making them the country's third-leading cause of death after heart disease and cancer. Even when they don't result in death, they diminish the quality of care and drive up costs across the healthcare system. This course in patient safety systems offers more insight into the major causes of medical error and what healthcare professionals can do to reduce risk through the use of specific technologies and processes.
Student Outcomes for the Graduate Certificate in Healthcare Quality
By earning the healthcare quality certificate, students are well positioned to pursue opportunities in healthcare administration, regulatory affairs and consulting. Demand for expertise in healthcare quality will likely rise as more providers take up VBR and alternative payment models, all of which prioritize outcomes over volume.
Healthcare quality management is a fast-evolving field focused on how providers can continuously improve their services. Careers such as director of quality management and vice president of quality and systems improvement are now viable options for MBA holders who specialize in quality. Professional organizations such as the National Association for Healthcare Quality have also emerged to help quality specialists find careers, network with peers and participate in the creation of new frameworks that make it more practical for providers to more toward measurably better patient outcomes.
The online Healthcare MBA at GW can be your entry point into a rewarding career as a healthcare quality expert. The program provides all of the rigor of a traditional on-campus MBA in a more convenient format, with no required residencies. Students learn with the help of GW's world-class faculty and benefit from the program's extensive alumni network. To learn more about the GW HCMBA, visit the main program page for a look at the degree requirements. You can also request a copy of our brochure from there.
Fee-For-Service, While Much Maligned, Remains The Dominant Payment Method For Physician Visits
Healthcare payments tied to value-based care on the rise, now at 34 percent
Medical Errors Are Third Leading Cause of Death in the U.S.