Notice2021-24042
VA Standards for Quality
Primary source
Metadata and text below are from the Federal Register, a public-domain U.S. government work. Always verify the official published version before relying on it for any legal matter.
Published
November 4, 2021
Issuing agencies
Veterans Affairs Department
Abstract
The Secretary of the Department of Veterans Affairs (VA) is soliciting public comment on VA's current standards for quality to ensure that they include the most up to date and applicable measures for veterans.
Full Text
<html>
<head>
<title>Federal Register, Volume 86 Issue 211 (Thursday, November 4, 2021)</title>
</head>
<body><pre>
[Federal Register Volume 86, Number 211 (Thursday, November 4, 2021)]
[Notices]
[Pages 60969-60970]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2021-24042]
-----------------------------------------------------------------------
DEPARTMENT OF VETERANS AFFAIRS
VA Standards for Quality
AGENCY: Department of Veterans Affairs.
ACTION: Solicitation of public comment.
-----------------------------------------------------------------------
SUMMARY: The Secretary of the Department of Veterans Affairs (VA) is
soliciting public comment on VA's current standards for quality to
ensure that they include the most up to date and applicable measures
for veterans.
DATES: Comments must be received on or before December 6, 2021.
ADDRESSES: Comments may be submitted through <a href="http://www.regulations.gov">www.regulations.gov</a>.
Comments should indicate that they are submitted in response to ``VA
Standards for Quality.'' Comments received will be available at
<a href="http://www.regulations.gov">www.regulations.gov</a> for public viewing, inspection or copies.
FOR FURTHER INFORMATION CONTACT: Joseph Francis, VHA Office of
Analytics and Performance Integration (API), 17 API, Veterans Health
Administration, Department of Veterans Affairs, 810 Vermont Avenue NW,
Room 668, Washington, DC 20420, (202) 461-5517. This is not a toll-free
number.
SUPPLEMENTARY INFORMATION: In accordance with section 1703C of 38
U.S.C., as added by section 104 of the VA Maintaining Internal Systems
and Strengthening Integrated Outside Networks Act of 2018 or the VA
MISSION Act of 2018, VA formally established standards for quality
regarding hospital care, medical services, and extended care services
furnished by the Department in October 2019 (84 FR 52932). VA's quality
standards were chosen based on a comprehensive assessment of health
care industry standards for quality, their relevance to veterans, and
the availability of comparative data for community providers. Wide
ranging expert guidance and stakeholder input was also sought from
veterans, Veteran Service Organizations, federal partners, health care
specialty associations and organizations, and the public through focus
groups, meetings, and requests for information. The current VA
standards for quality and associated measures are publicly available on
VA's Access to Care website (<a href="https://www.accesstocare.va.gov">https://www.accesstocare.va.gov</a>).
After internal review of VA's standards for quality in 2021,
significant changes were not made to the initial standards established
in 2019. The current quality standards address important dimensions of
care for veterans and are aligned with industry standards. The addition
of new metrics is limited in many cases by the lack of appropriate
community comparison data; and this has been compounded in CY 2020 and
2021 by the impact of the COVID-19 pandemic. Notably, the pandemic
resulted in gaps in the available healthcare data and temporary
suspension of some measures (e.g., COVID-19 Quality Reporting Programs
Guidance Memo--Centers for Medicare and Medicaid Services (CMS) (March
27, 2020); <a href="https://www.cms.gov/files/document/guidance-memo-exceptions-and-extensions-quality-reporting-and-value-based-purchasing-programs.pdf">https://www.cms.gov/files/document/guidance-memo-exceptions-and-extensions-quality-reporting-and-value-based-purchasing-programs.pdf</a>). This has created a problematic situation where, in some
cases, VA's current quality data results are being compared to pre-
COVID periods of community data. VA has an ongoing commitment to
evolving the quality standards in accordance with veteran needs and
industry advancements. The quality standards will be reviewed
internally again in FY 2022 to ensure they are up-
[[Page 60970]]
to-date and addressing veteran priorities. As required by 38 U.S.C.
1703C(b)(2), this notice is to solicit and consider public comment on
potential changes to VA's current quality standards to ensure that they
include the most up-to-date and applicable measures for veterans. VA
will use the comments it receives to help update the quality standards.
Changes to the standards can be accessed by veterans and the public on
VA's Access to Care website (<a href="https://www.accesstocare.va.gov">https://www.accesstocare.va.gov</a>).
VA's current standards for quality consist of quality domains and
quality measures.
<bullet> Quality domains--broad categories of quality used to
describe the desired characteristics of care received by veterans,
whether furnished by VA or community-based providers.
<bullet> Quality measures--an evolving series of numeric indicators
that evaluate clinical performance within each of the quality domains.
The standards for quality and included domains are:
<bullet> Timely Care--provided without inappropriate or harmful
delays.
<bullet> Effective Care--based on scientific knowledge of what is
likely to provide benefits to veterans.
<bullet> Safe Care--avoids harm from care that is intended to help
veterans.
<bullet> Veteran-Centered Care--anticipates and responds to
veterans' and their caregivers' preferences and needs and ensures that
veterans have input into clinical decisions.
The current quality measures for the quality domains are detailed
below along with relevant annotations regarding changes since October
2019:
<bullet> Timely Care
[cir] Patient-reported measures on getting timely appointments,
care, and information
[cir] Wait times for outpatient care
<bullet> Effective Care
[cir] Risk adjusted mortality rate for heart attack
[cir] Risk adjusted mortality rate for pneumonia
[cir] Risk adjusted mortality rate for heart failure
[cir] Risk adjusted mortality rate for chronic obstructive
pulmonary disease
[cir] Smoking and tobacco use cessation--advising smokers to quit
[cir] Immunization for influenza
[cir] Controlling high blood pressure
[cir] Beta-blocker treatment after a heart attack
[cir] Comprehensive diabetes care--blood pressure control
[cir] Comprehensive diabetes care--Hemoglobin A1c poor control
[cir] Breast cancer screening
[cir] Cervical cancer screening
[cir] Improvement in function (short-stay skilled nursing facility
patients)
[cir] Newly received antipsychotic medications (short-stay skilled
nursing facility patients)
<bullet> Safe Care
[cir] Catheter associated urinary tract infection rate
[cir] Central line associated bloodstream infection rate
[cir] Clostridioides difficile infection rate (Note: VA does not
currently have patient level comparison data for this measure. VA is
undertaking improvements to strengthen the reporting approach going
forward as data availability changes.)
[cir] Death rate among surgical patients with serious treatable
complications (Note: Availability of accurate community comparison data
has improved since initial publication of this measure in 2019 and
related updates will be made to VA's external reporting of this
measure.)
[cir] New or worsened pressure ulcers/pressure injuries (short-stay
skilled nursing facility patients)
[cir] Falls with major injury (long-stay skilled nursing facility
patients)
[cir] Physical restraints (long-stay skilled nursing facility
patients)
<bullet> Veteran-Centered Care (Note: VA now utilizes the measure or
composite for these key indicators of patient experience, rather than
the star rating, because this allows more precision in comparisons and
can better track improvement over time.)
[cir] Hospital Consumer Assessment of Health Providers and Systems
(HCAHPS) overall rating of hospital
[cir] HCAHPS care transition composite
[cir] Patient's overall rating of the provider on the Consumer
Assessment of Health Providers and Systems (CAHPS) survey
[cir] Patient's rating of coordination of care on the CAHPS survey
Signing Authority
Denis McDonough, Secretary of Veterans Affairs, approved this
document on October 28, 2021, and authorized the undersigned to sign
and submit the document to the Office of the Federal Register for
publication electronically as an official document of the Department of
Veterans Affairs.
Michael P. Shores,
Director, Office of Regulation Policy & Management, Office of General
Counsel, Department of Veterans Affairs.
[FR Doc. 2021-24042 Filed 11-3-21; 8:45 am]
BILLING CODE 8320-01-P
</pre></body>
</html>Indexed from Federal Register on November 4, 2021.
This is legal information, not legal advice. Laws vary by jurisdiction and change frequently. Always verify current law with official sources and consult a licensed attorney in your jurisdiction for advice on your specific situation.