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Patient Lives Saved As Performance Continues to Improve in CMS, Premier Healthcare Alliance Pay-for-Performance Project

Posted on: Tuesday, 17 June 2008, 18:00 CDT

The more than 1.1 million patients treated in five clinical areas at hospitals participating in a Centers for Medicare & Medicaid Services (CMS), Premier healthcare alliance pay-for-performance project are living longer and receiving recommended treatments more frequently.

According to results released today, more than 250 hospitals participating in the CMS/Premier Hospital Quality Incentive Demonstration (HQID) project have raised overall quality by an average of 15.8 percent over three years based on their delivery of 30 nationally standardized and widely accepted care measures to patients in five clinical areas.

Improvements in quality of care saved the lives of an estimated 2,500 heart attack patients across the first three years of the project, according to an analysis of mortality rates at hospitals participating in the project. Patients also received approximately 300,000 additional recommended evidence-based clinical quality measures, such as smoking cessation, discharge instructions and pneumococcal vaccination, during that same timeframe.

To view comments from CMS, please visit: www.cms.hhs.gov/apps/media/press_releases.asp.

CMS announced that it will award incentive payments of more than $7 million to 112 top-performing hospitals in Year 3, representing the top 20 percent of hospitals in each of the project's five clinical areas. Overall, 206 awards were given to these top-performing hospitals in the third year of the project. Through the project's first three years, CMS has awarded more than $24.5 million to top performers.

"The findings from the first three years of the HQID project clearly show that transparency with rewards for quality achieves a higher level of performance in American hospitals," said Richard Norling, president and chief executive officer of Premier. "This important connection between increased quality and performance creates value to patients, as well as the healthcare system."

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. This holds true for all types of participants - small and large, urban and rural, teaching and non-teaching.

Additional research by Premier using the Hospital Compare dataset for April 2006 to March 2007 showed that HQID participants scored on average 7.48 percentage points higher (91.49 percent to 84.01 percent) than non-participants when evaluating 19 common Hospital Compare measures.

Top performers

"Quality continues to be the number one non-negotiable value that drives us. A great deal of time and energy is placed on infusing quality initiatives throughout our institution," said John P. Ferguson, president and chief executive officer of Hackensack University Medical Center (HUMC) in Hackensack, N.J. "This is especially important and comforting to our patients and their families who place their trust in us." Over the project's first three years, HUMC received the highest total award - $1.88 million - and cared for almost 8,000 Medicare patients, the most among all participants.

"Quality is the overriding strategic comparative and the first thing we think of when treating patients," said Joseph Cacchione, MD, FACC, executive vice president of Saint Vincent Health System in Erie, Pa. "We have been able to develop a check and balance system that includes everyone and it means that everyone is responsible for the care of the patient. At this point we have seen improvements but we also know we are not done. This is an ongoing process and we now need to stretch ourselves to the next level." St Vincent, which also received the 2008 Premier Award for Quality, was the only Year 3 hospital to place in the top two deciles in all five clinical areas.

"We continue to perform exceptionally well, even though the bar keeps being raised," said Thinh Tran, M.D., chief quality and patient safety officer at Baptist Health South Florida of Miami, Fla. "This kind of performance illustrates that we have hard-wired quality and patient safety into all of our hospitals and outpatient facilities as indicated by these and other measures." Baptist Health South Florida hospitals placed in the top two deciles in 10 of 16 possible clinical areas across their four facilities participating in the demonstration project in Year 3.

"Hospitals participating in the HQID project make quality a top priority from the hospital board on down," said Stephanie Alexander, senior vice president, Premier Healthcare Informatics. "These top-performing hospitals - small and large, urban and rural, teaching and non-teaching - have demonstrated a continuous and sustained improvement, and we commend them for their dedication to provide the highest quality patient care."

About the HQID project

The HQID is the first national project of its kind, designed to determine if economic incentives to hospitals are effective at improving the quality of inpatient care. Through the project, Premier collects a set of more than 30 evidence-based clinical quality measures, developed by government and private organizations, from participating hospitals.

For hospitals participating in the HQID project, the average Composite Quality Score (CQS), an aggregate of all quality measures within each clinical area, improved by 4.4 percent between the project's second and third year for total gains of 15.8 percent over the project's first three years:

-- From 87.5 percent to 96.1 percent for patients with AMI (heart attack);

-- From 84.8 percent to 97.4 percent for patients with coronary artery bypass graft (CABG);

-- From 64.5 percent to 88.7 percent for patients with heart failure (HF);

-- From 69.3 percent to 90.5 percent for patients with pneumonia (PN);

-- From 84.6 percent to 96.9 percent for patients with hip and knee (HK) replacement.

The pay-for-performance model used in the first three years of the project includes financial incentives for the top 20 percent of hospitals in each of the five clinical areas. The top 10 percent of hospitals receive a 2 percent incentive payment for patients in that clinical area. Hospitals in the second decile receive a 1 percent incentive payment. Hospitals in the top 50 percent of each clinical area receive public recognition on the CMS Web site.

For complete information about the HQID project and to view those hospitals ranking in the top 50 percent in each focus area, visit www.premierinc.com/quality-safety/tools-services/p4p/hqi/index.jsp.

Project extension

CMS extended the project for three additional years to test the effectiveness of new incentive models and ways to improve patient care. The extension will continue to track hospital performance in the clinical areas of pneumonia, heart bypass, heart attack (acute myocardial infarction), heart failure, and hip and knee replacement. New measures, such as the AHRQ PSI Composite measure, length of stay and complications will be tested in these clinical areas. In addition, new areas will be added for testing, such as Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), Surgical Care Improvement Project (SCIP) and Ischemic Stroke.

The extension will also allow the testing of new reward models. Beginning with Year 4 results, participants will receive awards not only for top performance but also for achieving:

-- A defined level of quality, or quality threshold.

-- High quality improvements that also achieve the quality threshold.

Congress has mandated that Medicare develop a plan to implement value-based purchasing, which ties payment to quality of care and other outcomes, beginning with FY2009. The HQID project is a test of one value-based purchasing model and served as a guideline for CMS' recent value-based purchasing proposal to Congress.

About Premier Inc., 2006 Malcolm Baldrige National Quality Award recipient

Serving more than 2,000 U.S. hospitals and 51,000-plus other healthcare sites, the Premier healthcare alliance and its members are transforming healthcare together. Owned by not-for-profit hospitals, Premier operates one of the leading healthcare purchasing networks and the nation's most comprehensive repository of hospital clinical and financial information. A subsidiary operates one of the nation's largest policy-holder owned, hospital professional liability risk-retention groups. A world leader in helping healthcare providers deliver dramatic improvements in care, Premier is working with the United Kingdom's National Health Service North West and the Centers for Medicare & Medicaid Services to improve hospital performance. Headquartered in San Diego, Premier has offices in Charlotte, N.C., Philadelphia and Washington. For more information, visit www.premierinc.com.

Source: Business Wire

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