Nationwide use of performance measures related to just two clinical areas—coronary artery bypass graft surgery and pneumonia—could have saved hospitals as much as $1 billion in 2004.
That conclusion is part of an analysis from Premier Inc., an alliance of not-for-profit hospitals and health care systems. Officials at Premier also estimated that use of the same performance measures would have improved quality of care in hospitals resulting in about 3,000 fewer deaths, 6,000 fewer complications, 6,000 fewer readmissions, and 500,000 fewer days in the hospital nationwide over 1 year.
The analysis is an extrapolation of the first-year results of a Medicare pay-for-performance demonstration project that involved more than 250 Premier member hospitals in 38 states around the country. As part of the demonstration project, which began in October 2003, Premier collected data on the use of quality indicators for five clinical conditions—myocardial infarction, coronary artery bypass graft (CABG), pneumonia, heart failure, and hip and knee replacement.
The Centers for Medicare and Medicaid Services offered incentive payments to hospitals based on their performance on the quality indicators. The 3-year project is still ongoing but the first-year results showed improvements in all clinical categories.
As part of its national analysis, Premier concentrated on two high-volume diagnoses—pneumonia and CABG—and extrapolated outcomes for the use of seven pneumonia measures and four CABG measures. The predictions on cost savings and quality improvement are based on all pneumonia and CABG patients receiving 76% or more of the recommended performance measures.
“Improving patient care in these two clinical areas … can be proven statistically to reduce costs, save a noticeable number of lives, to reduce complications of care, to reduce readmissions, and to shorten length of stay,” Richard A. Norling, president and CEO of Premier, said during a teleconference to announce the results of the analysis.
For pneumonia patients, Premier officials estimated the impact of oxygenation assessment, pneumococcal vaccination, blood culture before first antibiotic, adult smoking cessation counseling, initial antibiotic selection, initial antibiotic within 4 hours of hospitalization, and influenza vaccination.
For CABG patients, Premier calculated the effect of aspirin prescribed at discharge, prophylactic antibiotic selection for surgical patients, prophylactic antibiotic within 1 hour prior to surgical incision, and prophylactic antibiotic discontinued within 24 hours after the end of surgery.
For more information on the Premier analysis of the impact of performance measures, go to www.premierinc.com/p4p/press