Hospitals participating in the Hospital Quality Incentive Demonstration value-based purchasing project funded by the Centers for Medicare and Medicaid Services raised their overall quality by 17% over 4 years, the agency reported.
The program, launched in 2003 by the CMS and Premier Inc., an alliance of not-for-profit hospitals and health care systems, is designed to test Medicare payment incentives. The goal is to determine if the incentives will improve the safety, quality, and efficiency of inpatient treatment of acute myocardial infarction, coronary artery bypass graft (CABG), heart failure, pneumonia, and hip and knee replacement. The CMS awarded $12 million in year 4 to 225 hospitals. The program determines average composite quality scores for the five areas using more than 30 evidence-based clinical quality measures developed by the Joint Commission and other groups.
In year 4, the mean score had improved most for heart failure patients and pneumonia patients. The heart failure score rose from 64.5% to 92.2%, based on measures that included evaluation of left ventricular systolic function and smoking cessation counseling. The score for pneumonia rose from 69.3% to 92.6%, with measures including appropriate initial antibiotic selection and influenza vaccination.
Hip and knee replacement scores rose from 84.6% to 97.2%, based on measures such as the use of prophylactic antibiotics and the 30-day rerate. For MI patients, the average scores improved from 87.5% to 96.3%, with measures for reporting including administration of aspirin and beta-blockers on arrival, and primary percutaneous coronary intervention within 90 minutes of arrival. According to Premier, the performance improvement saved the lives of an estimated 4,700 MI patients over 4 years.
The average score for CABG patients was up from 84.8% to 98.5%, based on measures that included the use of aspirin at discharge and inpatient mortality.
The shift to paying for health care based on performance rather than volume is often cited as a primary goal of health reform. The reform bills that have surfaced so far this year do not provide much detail on how programs like HQID could be expanded beyond the demonstration phase, although there has been attention to the processes for selecting and validating new quality measures.
Brooke McManus is a reporter for The Gray Sheet. This newspaper and The Gray Sheet are published by Elsevier.