CENTERS FOR MEDICARE

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CENTERS FOR MEDICARE MEDICAID SERVICES(CMS)
A Tale of Hospital Public Reporting View from
CMSSheila H. Roman, MD, MPHSenior Medical
Officer Quality Measurement and Health
Assessment GroupCMSMay 25, 2005
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Overview of Todays Talk

• Hospital Quality Alliance
• Hospital Quality Incentive Demonstration with
  Premier, Inc.
• Successes
• Challenges
• Next Frontiers

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Hospital Quality Alliance (HQA) Improving Care
Through Information

• End-game
• excellent quality care
• To get there
• one robust, nationally standardized and
  prioritized set of measures reported by every
  hospital in the country, accepted by all
  purchasers, overseers and accreditors
• Collaborations, standardization, oversight,
  incentives, commitment, leadership

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HQA Current Status

• Starter set of 10 measures (bolstered by MMA
  market basket payment update incentive to PPS
  hospitals)
• Over 4,000 hospitals reported in November, 2004
  and April, 2005
• More clinical measures (10 to 17 to 22 through
  summer 2005) with more planned to come
• Standardized patient perception of care survey
  measures using HCAHPS (by 2007)

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Hospital Public Reporting
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HQA Transition to Hospital Compare

• Hospital Compare is a place for consumers to
  start a conversation with their physicians about
  how to get the best care. Hospital Compare
  equips consumers to
• think more concretely about quality
• realize that quality can differ across facilities
• understand that valid and widely used measures of
  quality can be a tool to help understand quality
  differences
• learn that individuals can impact quality through
  their questions and their choices
• Data is the heart of the Hospital Compare Tool

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CMS Hospital Quality Incentive (HQI) Demonstration

• 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?

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CMS HQI Demonstration Over 270 National
participating hospitals
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CMS HQI Demonstration

• 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.
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Anticipated payment scenario
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Successes of Public Reporting

• Transparency and accountability
• Alignment of CMS/JCAHO common measures/measure
  standardization
• Collaborations
• Use of data to identify clinical opportunities
• Routine measurement of quality
• Culture of quality

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Challenges to Public Reporting

• Selection of measures/off label use of measures
• Hospital Burden
• Dynamic measurement environment
• Unintended consequences
• Time lags and feedback
• Need for proof of effectiveness

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Next Frontiers of Public Reporting

• Clinician and consumer engagement
• Measurement of other dimensions of quality
• Scoring methodologies
• Benchmarking
• Incentives/Performance-based Reimbursement
• Health Information Technology
• Transformational change in health care

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Thank you!

• Sheila H. Roman, MD, MPH
• 410-786-6004
• sheila.roman_at_cms.hhs.gov