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Seeweekly news
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2005-11-14 |
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CMS/Premier Pay-For-Performance Model Produces Remarkable Quality Improvements Among Nation's Hospitals |
"Pay-for-performance" can increase clinical quality and save lives, according to the first year of official data from a national project involving more than 260 hospitals. The Centers for Medicare and Medicaid Services (CMS) will pay $8.85 million in incentives to the top-performing hospitals in the project, which is managed by Premier Inc.
Data from the first year of CMS/Premier Hospital Quality Incentive Demonstration (HQID), validated by CMS and reported publicly today, demonstrate a significant improvement in the quality of care across five clinical focus areas as measured by 33 nationally standardized and widely accepted quality indicators. The average improvement across the clinical areas was 6.6%. These performance gains have outpaced those of hospitals involved in other national performance initiatives. Approximately 235 acute myocardial infarction (heart attack) patients were saved as a result of quality improvements in that related focus area alone.
Medicare is awarding $8.85 million to hospitals that achieved the highest levels of performance at the end of the first year of the project. This is the first time that Medicare has awarded actual monetary bonuses to health care providers in a pay-for-performance demonstration.
"The ultimate goal of the HQID is to determine whether pay for performance impacts the quality of care in our nation's hospitals," said Richard Norling, president and chief executive officer of Premier Inc. "Findings from the first year of this project clearly indicate that it does."
The pay-for-performance model demonstrated in the project includes financial incentives and public recognition for top-performing hospitals as well as financial penalties for hospitals that do not improve above a pre- defined quality measure threshold by the third year of the project. Additionally, Premier's relationship with participants enabled implementation of effective, collaborative knowledge transfer programs supporting identification and dissemination of best practices of top performers, a key component to the rapid pace of performance improvement.
The financial component of the HQID will reward hospitals performing in the top 10 percent for a given clinical focus with an additional 2 percent bonus on their Medicare payments for patients in that clinical area. Hospitals in the second decile will receive a 1 percent bonus.
Of the $8.85 million CMS will award for year one, the largest single award, $326,000, will go to Hackensack University Medical Center in New Jersey for care of patients with coronary artery bypass graft (CABG) surgical procedures. Hackensack was a top performer in all five areas and cared for more Medicare patients than any other provider. Their total award across the focus areas will be nearly $848,000.
The second largest single award totals $249,000 and will be provided to the Bone and Joint Hospital in Oklahoma City, Okla., part of SSM Health Care, for exceptionally high quality of care for patients receiving hip and knee replacement procedures.
"Premier has been committed to working with hospitals to improve clinical quality and patient outcomes for more than a decade," said Norling. "We believe this model, which includes a rich collaborative environment created and supported by Premier, brings together the incentive, collaboration, and technology components that are resulting in this remarkable pace of improvement."
Unlike other performance improvement initiatives that only monitor processes of care associated with three focus areas, the HQID, which began in October 2003, tracks process and outcome measures in five clinical areas - acute myocardial infarction (AMI), heart failure, coronary artery bypass graft (CABG), pneumonia, and hip and knee replacement.
Composite quality scores, an aggregate of all quality measures, improved between the first and last quarters of the first year of the demonstration in all 5 clinical focus areas:
- From 87 percent to 91 percent for patients with acute myocardial \
infarction (heart attack).
- From 65 to 74 percent for patients with heart failure.
- From 69 percent to 79 percent for patients with pneumonia.
- From 85 percent to 90 percent for patients with coronary artery bypass
graft.
- From 85 percent to 90 percent for patients with hip and knee
replacement.
Five hospitals performed within the top 20 percent for all focus areas in which they participated in year one. Hackensack University Medical Center (Hackensack, N.J.) and McLeod Regional Medical Center (Florence, S.C.) were top performers in all five focus areas; Fairview Lakes Regional Medical Center (Wyoming, Minn.), part of Fairview Health Services, placed in the top deciles for all three clinical conditions in which they participated; and Bone and Joint Hospital (Oklahoma City, Okla.), part of SSM Health Care, and Presbyterian Hospital of Allen (Allen, Texas), part of Texas Health Resources, performed in the top deciles for the one clinical focus area in which they participated.
The range of variance among participating hospitals also is closing, as those hospitals in the lower deciles continue to improve their quality scores and close the gap between themselves and the demonstration's top performers.
"Quality is a core value and a leadership priority in the demonstration's top performing hospitals," said Stephanie Alexander, senior vice president and general manager of Premier Healthcare Informatics. "These hospitals' outstanding clinical performance begins with executive support, a strong culture of quality, and the dedication of the appropriate resources."
For a complete review of the demonstration, the year one results, and to view those hospitals ranking in the top 50 percent in each focus area, visit www.premierinc.com/qualitydemo . |
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