Early%20Results%20from%20the%20Premier-CMS%20Hospital%20Quality%20Incentive%20Demonstration%20Program

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Early Results from thePremier-CMS Hospital
Quality Incentive Demonstration Program

• Stephanie Alexander
• Senior Vice President
• Premier, Inc.

The Quality Colloquium on the campus of Harvard
University August 23, 2005
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Program Introduction
CMS/Premier Hospital Quality Incentive (HQI)
Demonstration Project

• The first national project to measure hospital
  performance and offer additional Medicare payment
  for top quality care
• Pay for quality
• Can economic incentives effectively improve
  quality of care?

CMS/Premier HQI Demonstration Project
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Is there a business case for quality in
hospitals?
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CABG Performance
Source Premier PerspectiveTM
CMS/Premier HQI Demonstration Project
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Thomas Scully Former Administrator, Centers for
Medicare and Medicaid Services, 2003 I dont
think it makes a lot of sense to pay every
hospital in Boston exactly the same amount for a
hip replacement regardless of their quality, but
we are.
Mark McClellan, M.D., Ph.D. Administrator,
Centers for Medicare and Medicaid Services,
2004 "Our goal at Medicare is to stimulate care
that is efficient and effective for every
patient. The Premier/CMS demonstration, and
others that are a part of the new Medicare law,
will help us work with providers to improve the
quality of care that our beneficiaries receive."
Premier/CMS HQI Demonstration Project
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Program Overview

• A three-year effort linking payment with quality
  measures (launched October, 2003)
• Top performers identified in five clinical areas
• Acute Myocardial Infarction
• Congestive Heart Failure
• Coronary Artery Bypass Graft
• Hip and Knee Replacement
• Community Acquired Pneumonia

Indicators within AMI, CABG, HF, and CAP
represent all patients (all payers). Hip and knee
replacement indicators apply only to Medicare
patients.
CMS/Premier HQI Demonstration Project
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CMS/Premier HQI - National participationOver 270
participating hospitals
CMS/Premier HQI Demonstration Project
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Identifying Top Performers

• Composite Quality Index will identify hospitals
  performing in the top two deciles in each
  clinical focus group
• Composed of two components
• Composite Process Rate
• Risk-Adjusted Outcomes Index
• Clinical conditions without outcomes indicators
  use only the Composite Process Rate

CMS/Premier HQI Demonstration Project
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Payment Overview

• Top Performers are defined annually as those in
  the first and second decile
• Incentive payment threshold changes each year per
  condition
• Top decile performers in a given clinical area
  receive a 2 percent Medicare payment supplement
  per clinical condition
• Second decile performers receive a 1 percent
  Medicare payment supplement per clinical
  condition.

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Anticipated payment scenario
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Transparency in measures

• The CMS/Premier quality measures are based on
  clinical evidence and industry recognized metrics
  with standardized definitions from
• All 10 indicators from the National Voluntary
  Hospital Public Reporting Initiative
• 27 indicators from the National Quality Forum
  (NQF).
• 24 indicators from CMS 7th Scope of Work.
• 15 indicators from JCAHO Core Measures.
• 3 indicators proposed by The Leapfrog Group.
• 4 indicators from the Agency for Healthcare
  Research and Qualitys (AHRQ) patient safety
  indicators (2 PSIs applied to 2 clinical
  populations).

CMS/Premier HQI Demonstration Project
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Transparency in reporting

• Public reporting
• Top 50 of participants by clinical area
• No rankings
• Individual indicator values, not overall score
• Frequency every 6 to 12 months
• Expect first reporting Fall 2005
• Reporting within the group
• In most cases, fully transparent knowledge
  transfer

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Current ProgressHQI Results to Date
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CMS/Premier HQI ProjectAlready showing
significant improvement
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CMS/Premier HQI ProjectReduction in variation
and improvement trend (AMI)
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Reduction in variation and improvement trend CAP
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CMS/HQI Hospital Performance Against
BenchmarkOutperforming in all but six
indicatorsBenchmark JCAHO National Data
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How / why are hospitals improving?P4P?
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Rapid Improvement Portal
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Rapid Improvement Guides
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Premier Rapid Improvement Guides

• Best practices from HQI project top performers
• Leadership and Performance Improvement
  Infrastructure
• Improving Acute Myocardial Infarction (AMI) Care
• Improving Coronary Artery Bypass Graft (CABG)
  Care
• Improving Heart Failure Care
• Improving Hip Knee Replacement Care
• Improving Pneumonia Care

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The Hows

• Quality core value of institution
• Priority of executive team
• Physician engagement
• Improvement methodology
• Prioritization methodology
• Dedicated resources
• Committed knowledge transfer

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Knowledge Best Practice Transfer Website
Care Management Online Collaborative and Team
site under development

• www.BSHSIShare.com Web Site Screenshot Here

Welcome Building a Unified Bon Secours Health
System requires sharing and helping one other
through the latest technology tools and working
smarter. This Web service is an initial pilot for
a new service to support sharing across BSHSI
using online tools and.
Nursing Collaborative Nurse Agency
Reduction Click Here
Care Management Collaborative CMS Teams Coming
Soon
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Catholic Health PartnersParticipants Versus
Non-Participants
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Comparing overall composite score w/
all-or-nothing scoreOne large health system
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Best Performer AMIHow Bundles
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For More Information

• Stephanie Alexander
• stephanie_alexander_at_premierinc.com

www.cms.hhs.gov/quality/hospital www.qualitydemo.
com