Assignment: NSGCB 468 Competency 2

Assignment: NSGCB 468 Competency 2

Assignment: NSGCB 468 Competency 2

Assessment Details

This assignment is designed to give you a greater understanding of regulatory agencies and accreditation bodies, including their functions and public reporting requirements, and how they impact quality and safety.

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Select and evaluate a regulatory agency or accrediting body.

Discuss the history of the agency or body.

Explain the reason for its existence.

Summarize the agency’s public reporting of quality indicators:

Frequency

Where they are reported

Why public reporting of these metrics is important

Explain how the agency or body operates:

Current function

Organizational structure

Governance

Analyze the impact the agency or body has on quality at each level of health care:

Health care organizations

Nursing practice

Patient care

Cite at least 2 sources in an APA-formatted reference page.

Assignment: NSGCB 468 Competency 2 Sample

Competency 2: Accrediting Body

Individuals and populations require high quality care. As a result, health care facilities should design and implement appropriate procedures and adhere to the expected quality standards. Accreditation agencies and regulatory bodies are pivotal in standardizing healthcare and ensure care facilities adhere to public health policies. Analyzing the values, history, and other core elements helps health care practitioners to understand them comprehensively. The purpose of this paper is to evaluate an accrediting body through its history, public reporting procedures, operation, and impact on health care quality at different levels.

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History and Reasons for Existence

Accreditation bodies have rich histories based on their operations over the years. The National Committee for Quality Assurance (NCQA) was established as an independent nonprofit organization in 1990 (NCQA, 2023). It commenced its work by measuring and accrediting health plans, and much has not changed since then. However, the body has expanded its scope to measure the quality of medical providers and practices (NCQA, 2023). The purpose of an organization’s existence can be derived from its mission and vision. Regarding NCQA, its mission is to improve health care. It envisions better health care and choices for individuals and the public. Accordingly, it is instrumental in optimizing care outcomes by standardizing quality.

NCQA’s Public Reporting of Quality Indicators

NCQA reports quality indicators through Healthcare Effectiveness Data and Information Set (HEDIS). Regarding the frequency of reporting, HEDIS measurement and reporting period is yearly, implying that data collected in a particular year is reported in the following year. The Centers for Medicare & Medicaid contracts NCQA to collect HEDIS measures relating to significant health issues, including heart disease, cancer, and diabetes (CMS.gov, 2023). NCQA ensures that HEDIS stays current yearly through it Committee on Performance Measurement. Public reporting of HEDIS metrics is crucial for individuals and facilities to compare health plans. The data can also be used to benchmark performance and compare providers.

How NCQA Operates

NCQA’s current function is primarily accrediting health care plans. This is achieved through intensive assessment of a plan’s structure and process. Other focus areas include clinical quality and patient satisfaction (NCQA, 2023). On organizational structure, NCQA is a centralized organization, where the President is at the pinnacle of leadership. Its founder, Margaret R. O’Kane, is the current President. Regarding governance, NCQA is governed by a board of directors. Organizations governed by a board of directors are answerable to owners, mainly shareholders and stakeholders (Chen et al., 2021). As a result, NCQA’s board of directors oversees the organization and makes decisions on behalf of stakeholders and shareholders.

NCQA’s Impact on Quality

Health care organizations are mandated to provide high care-quality to all individuals and groups. As a rigorous external review of care procedures, accreditation ensures that an institution or program’s quality meets the standards and regulation of the accrediting body (Hussein et al., 2021). Therefore, NCQA’s accreditation helps health care organizations to improve their processes. To the nursing practice, accreditation ensures that the profession achieves its goal of providing excellent care characterized by high quality and patient satisfaction. Above all, NCQA facilitates patient care optimization by ensuring health programs are continually improved as situations obligate. Patient outcomes improve when health care facilities implement preventive measures, advanced medication management practices, and screening programs, among other initiatives for high performance to meet accreditation requirements.

Conclusion

Accreditation and regulation are crucial for sustained care quality. A detailed review of NCQA demonstrates an organization committed to excellence at the individual and organizational levels. To be accredited, health care plans and programs must meet the expected standards. This requirement guarantees individuals and the broader public high quality care.

References

Chen, K. C., Hsieh, F. C., & Hsiao, Y. J. (2021). Hospital board of directors’ composition and financial performance: empirical evidence from Taiwan. Inquiry: a Journal of Medical Care Organization, Provision and Financing, 58, 469580211024897. https://doi.org/10.1177/00469580211024897

CMS.gov. (2023). Healthcare Effectiveness Data and Information Set (HEDIS). https://www.cms.gov/medicare/health-plans/specialneedsplans/snp-hedis

Hussein, M., Pavlova, M., Ghalwash, M., & Groot, W. (2021). The impact of hospital accreditation on the quality of healthcare: a systematic literature review. BMC Health Services Research, 21(1), 1-12. https://doi.org/10.1186/s12913-021-07097-6

NCQA. (2023). About us. https://www.ncqa.org/about-ncqa/

NCQA. (2023). Leadership. https://www.ncqa.org/about-ncqa/leadership/