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date: 18 September 2019

Abstract and Keywords

Healthcare quality measures help providers identify deficiencies and track improvement, guide patients seeking higher quality care, and facilitate payment systems that reward quality. To perform these functions well, measures must be thoughtfully selected, carefully designed, accurately calculated, and clearly reported. This chapter discusses legal and policy tools for achieving these goals. It describes how policy-makers have sought to strengthen the data foundation for measurement and streamline measurement initiatives. It then reviews mechanisms for ensuring the quality of quality measures. It examines actions that payers, providers, patients, and regulators could take to challenge faulty quality information, including suits based on contract terms, suits based on fraud and abuse laws, and tort suits based on theories of defamation and lack of informed consent. Ultimately, it suggests that to address measurement concerns, policy makers should focus on supporting research and promoting information technology that facilitates new forms of quality measurement.

Keywords: law, quality, health, healthcare, Patient Protection and Affordable Care Act, measurement, reporting, information technology, fraud, informed consent

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