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Regulatory bodies, therefore, keep an eye on individuals and corporate healthcare practitioners and institutions, and tell the government about developments in the industry, enforce more significant safety standards and work to improve healthcare quality while adhering to local, state, and federal guidelines. Healthcare compliance professionals are needed to help clinical institutions and organizations comply with the ever-increasing government requirements that define patient privacy and usage standards, maintain quality patient care, prevent fraud and protect healthcare staff. Healthcare policy is significant because it aids in establishing guidelines that benefit patients, healthcare organizations, and our healthcare system. Protocols can help to avoid human error and poor communication when it comes to medical decisions. In the healthcare industry and health insurance coverage, regulation is essential. The numerous regulatory entities protect the public from various health risks and provide several public health and welfare services. These regulatory authorities work together to protect and control public health. The delivery of high-quality health care is part of the government’s responsibility to safeguard and advance society’s interests. Strong cooperation between federal, state, and local governments, as well as the business sector, will be required to achieve the aim of high-quality treatment. Accreditation is a self-evaluation and external peer assessment system used by health care institutions to measure their level of performance by setting standards correctly and implementing ways to improve consistently. The world is interested in hospital accreditation.

Accreditation has been found in studies to increase the overall quality of healthcare. Accreditation necessitates workers holding themselves to high patient-care standards. This also enhances care quality by reducing disparities in how different staff members and departments treat patients. The accreditation’s primary purpose is to ensure that hospitals follow evidence-based procedures and prioritize healthcare access, cost, efficiency, quality, and effectiveness. This demonstrates that the accredited hospital will be recognized globally. Better performance on CMS key measures for ACS and HF patients is linked to accreditation. Enhances the quality of the results. It gives facilities a competitive edge by demonstrating their dedication to higher standards—processes for diagnosing and treating patients quickly and correctly.

Analyze patient outcomes and collect data. You can’t manage something that can’t be measured. The first step in enhancing the quality of care at your company is to examine your current statistics to see where improvements may be made. To find areas for improvement, you should review your patient population and your organization’s operations.

I worked for an Insurance company’s quality department. We had an application that was used by the clients called Cozeva. Cozeva allows organizations to keep track of the CMS requirements. Physicians can identify their gaps in care. The Medicare Advantage program requires that physicians participate in two different surveys. The Consumer Assessment of Health Providers (CAHPS) and Health Outcomes Survey (HOS) survey. The CAHPS is designed to assess patients’ experience with their health care providers’ visits. The HOS survey is to gather patients to report quality of living data. Both of these surveys are completed annually, and based on the star measures results, physicians can receive a monetary bonus.  

Astrue, M. J. (1994). Health Care Reform and the Constitutional Limits on Private Accreditation as an Alternative to Direct Government Regulation. Law and Contemporary Problems57(4), 75–87. https://doi.org/10.2307/1192057

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