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Overview of Today’s Presentation. Strategies available to CMS to improve quality Focus on public reporting and consumer information Current Quality Initiatives, with focus on Hospital work. Pursuing Excellence. WHAT WE CAN DO TO IMPROVE QUALITY. MANAGE PROCESS IN PARTNERSHIP

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Overview of today s presentation

Overview of Today’s Presentation

  • Strategies available to CMS to improve quality

  • Focus on public reporting and consumer information

  • Current Quality Initiatives, with focus on Hospital work


Pursuing excellence

Pursuing Excellence


Overview of today s presentation

WHAT WE CAN DO TO IMPROVE QUALITY

MANAGE PROCESS IN PARTNERSHIP

WITH STAKEHOLDERS

SELECT PRIORITY AREAS

ADOPT OR DEVELOP MEASURES

COLLECT & ANALYZE DATA

IDENTIFY IMPROVEMENT OPPORTUNITIES AND

SELECT APPROPRIATE IMPROVEMENT INTERVENTIONS

SUPPORT STANDARD METHODS

PROMOTE OR CREATE COLLABORA-TIONS AND

PARTNER-SHIPS

GIVE

PLANS, DOCTORS

&

PROVIDERS TECHNICAL

ASSISTANCE

GIVE CONSUMERS INFOR-MATION

AND ASSISTANCE TO MAKE CHOICES

STRUCTURE COVERAGE AND PAYMENTS TO IMPROVE CARE

REWARD DESIRED PERFORM-ANCE

ESTABLISH

&

ENFORCE STANDARDS

3


Cms approach to quality

CMS Approach to Quality

  • Announced November 2001 by Secretary Thompson:

    • Empower consumers to make more informed decisions regarding their healthcare

    • Stimulate / support providers & clinicians to improve the quality of health care


A focus on consumer information complemented by additional tactics

SUPPORT STANDARD METHODS

PROMOTE OR CREATE COLLABORA-TIONS AND

PARTNER-SHIPS

GIVE

PLANS, DOCTORS

&

PROVIDERS TECHNICAL

ASSISTANCE

GIVE CONSUMERS INFOR-MATION

AND ASSISTANCE TO MAKE CHOICES

REWARD DESIRED PERFORM-ANCE

STRUCTURE COVERAGE AND PAYMENTS TO IMPROVE CARE

ESTABLISH

&

ENFORCE STANDARDS

A focus on consumer information, complemented by additional tactics


Comparative quality information on www medicare gov

Comparative Quality Information on www.medicare.gov

  • Medicare Health Plan Compare - 1999

  • Dialysis Facility Compare - 2001

  • Nursing Home Compare - 2002

  • Home Health Compare – 2003

  • Hospital Compare – 2004


The national voluntary hospital reporting initiative

The National Voluntary Hospital Reporting Initiative

  • A partnership

    • American Hospital Association, Federation of American Hospitals, Assoc of American Medical Centers, The Disclosure Group (consumer, union and private purchaser advocates), National Quality Forum, JCAHO, American Medical Association, Nat Assoc of Hosp for Children and Related Inst, Agency for Healthcare Research and Quality, AFL-CIO

  • Public reporting and building of a data infrastructure simultaneously


The national voluntary hospital reporting initiative1

The National Voluntary Hospital Reporting Initiative

  • Phase I: report starter set of 10 measures (NOW in progress)

  • Phase II: report standardized patient perception of care survey (HCAHPS) (late 2004 at earliest)

  • Phase III: more measures


The premier hospital quality incentive demonstration

The Premier Hospital Quality Incentive Demonstration

  • A demo is a way for CMS to send a new message, to test new payment methods

  • This demo: Test how/if financial incentives drive superior quality inpatient care

  • CMS demonstration with Premier, Inc.

  • Reports the performance data on www.cms.hhs.gov


The premier hospital quality incentive demonstration1

The Premier Hospital Quality Incentive Demonstration

5 clinical conditions (34 measures)

  • Acute MI

  • Heart Failure

  • Pneumonia

  • Coronary Artery Bypass Graft

  • Hip and Knee Replacement


The premier hospital quality incentive demonstration2

The Premier Hospital Quality Incentive Demonstration

  • Top 50% of hospitals in each clinical area publicly acknowledged on CMS website

  • Bonuses for top 2 deciles for each condition

    • Top decile given 2% bonus of their Medicare DRG payments for that condition

    • Second decile given a 1% bonus

  • Possible penalty in third year for laggards


One possible payment scenario

One possible payment scenario

Condition X

Condition X

1st Decile

Hospital 2

2nd Decile

1st Decile

Condition X

3rd Decile

2nd Decile

4th Decile

5th Decile

3rd Decile

1st Decile

Top Performance Threshold

4th Decile

6th Decile

2nd Decile

5th Decile

7th Decile

3rd Decile

6th Decile

8th Decile

4th Decile

9th Decile

7th Decile

5th Decile

10th Decile

8th Decile

6th Decile

9th Decile

7th Decile

Payment Adjustment Threshold

10th Decile

8th Decile

9th Decile

10th Decile

Year One

Year Two

Year Three


The premier hospital quality incentive demonstration3

The Premier Hospital Quality Incentive Demonstration

  • Voluntary

  • Eligibility: Hospitals in Premier Perspective system as of March 31, 2003

  • 300 hospitals anticipated to participate

  • Demonstration Project: test of concept

  • Could be expanded (with modifications) in the future


Doctor s office quality doq project early stages now

Doctor’s Office Quality (DOQ) Project (early stages now)

  • Topics: Preventive care, DM, HTN, CAD, HF, Osteoarthritis, Depression, patient perceptions of care, assessment of systems of care.

  • Clinical measures

    • Developed in conjunction with AMA/Consortium and with expert panel

    • Exploring ability to create composite score

    • Exploring use of claims-based data, EHRs.

  • Process improvements

    • Care reminders, other


Doq it objectives

DOQ-IT: Objectives

  • Promote adoption and use of IT in physician offices

  • Create infrastructure for QIO to receive data from electronic office-based systems for use in confidential technical assistance and public reporting

    Just starting this – completing some early contracting


Doq it what qios will do

DOQ-IT: What QIOs will do

  • Assist physicians in decision to adopt

    • Costs and benefits

    • Systems availability – registry/EHR

    • Systems information

  • Provide implementation assistance

    • Technical issues

    • Workflow redesign

  • Receive electronic data from physicians and provide improvement assistance

    • EHR specifications for clinical measures and systems operating reports

    • Process redesign to support chronic care management


Doq it potential demonstration

DOQ-IT: Potential Demonstration

  • Requirements for payment

    • Adopt specified IT systems to improve safety/quality and to manage patients with chronic disease

      • Full EHR or

      • E-Rx, e-lab results management, e-registry

    • Demonstrate use of such systems through electronic data transmitted to QIO

    • Meet performance targets – public reporting

    • Meet cost reduction targets (in aggregate)

  • Coordination with Bridges to Excellence program


More information

More Information

  • http://www.cms.hhs.gov/quality/

    Fact sheets on: Hospital Quality Initiative; 3 State Hospital Pilot; H-CAHPS; Nursing Home and Home Health Quality Initiatives, more


Thank you

Thank you

Barbara R. Paul MD

410-786-5629

[email protected]


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