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CMS-Premier Hospital Quality Incentive Demonstration Project . Stephanie Alexander Senior Vice President Premier Inc. Healthcare Informatics www.qualitydemo.com. About Premier.

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cms premier hospital quality incentive demonstration project

CMS-Premier Hospital Quality Incentive Demonstration Project

Stephanie Alexander

Senior Vice President

Premier Inc.

Healthcare Informatics

www.qualitydemo.com

Alexander 2004

about premier
About Premier
  • Premier, Inc., is a strategic alliance owned by 200 of the United States’ leading not-for-profit hospitals and healthcare systems.
    • These systems operate or are affiliated with nearly 1,500 hospitals and hundreds of other healthcare sites.

Owners

Affiliates

Alexander 2004

slide3

Is there a business case for quality in hospitals?

Performance

Group

Hospitals

Innovation

Group

Opportunity

Group

Top Performers

Lowest

Performance

Top decile in performance

(low cost and high quality)

Bottom quartile in performance

(high cost, low quality)

Alexander 2004

cabg performance
CABG Performance

Source: Premier PerspectiveTM

Alexander 2004

non collaborators financial performance
Non-collaborators’ financial performance

Source: Premier PerspectiveTM

Alexander 2004

collaborators financial performance
Collaborators’ financial performance

Source: Premier PerspectiveTM

Alexander 2004

cms premier hospital quality incentive demonstration project1
CMS/Premier Hospital QualityIncentive Demonstration Project
  • A three-year effort linking payment with quality measures
  • Top performers identified in five clinical areas
    • Acute Myocardial Infarction
    • Congestive Heart Failure
    • Coronary Artery Bypass Graft
    • Hip and Knee Replacement
    • Pneumonia
  • 278 participating hospitals nationwide

Alexander 2004

identifying top performers
Identifying Top Performers
  • Composite Quality Index will identify hospitals performing in the top two deciles in each clinical focus group
  • Composed of two components:
    • Composite Process Rate
    • Risk-Adjusted Outcomes Index
      • Clinical conditions without outcomes indicators use only the Composite Process Rate

Alexander 2004

widely accepted quality measures
Widely accepted quality measures

The CMS/Premier quality measures are based on clinical evidence and industry recognized metrics, including:

  • All 10 indicators from the National Voluntary Hospital Public Reporting Initiative
  • 27 indicators from the National Quality Forum (NQF).
  • 24 indicators from CMS 7th Scope of Work.
  • 15 indicators from JCAHO Core Measures.
  • 3 indicators proposed by The Leapfrog Group.
  • 4 indicators from the Agency for Healthcare Research and Quality’s (AHRQ) patient safety indicators.

Alexander 2004

medicare payment incentives
Medicare Payment Incentives
  • Incentive payment threshold changes annually for each clinical condition
  • Top decile performers in a given clinical area receive a 2 percent payment supplement per condition
  • Second decile performers receive a 1 percent payment supplement per condition.
  • Reduced payments in year 3:
    • 1% reduction if < year one ninth decile
    • 2% reduction if < year one tenth decile

Alexander 2004

anticipated payment scenario

Condition X

Condition X

Condition X

1st Decile

2nd Decile

1st Decile

3rd Decile

Hospital

4th Decile

1st Decile

2nd Decile

Top Performance Threshold

5th Decile

3rd Decile

6th Decile

2nd Decile

4th Decile

7th Decile

5th Decile

8th Decile

3rd Decile

9th Decile

6th Decile

4th Decile

10th Decile

7th Decile

Hospital

5th Decile

8th Decile

9th Decile

6th Decile

10th Decile

7th Decile

Payment Adjustment Threshold

Hospital

8th Decile

9th Decile

10th Decile

Year One

Year Two

Year Three

Anticipated payment scenario

Alexander 2004

slide12

Heart Failure: Pre-release vs 4Q03 Median Comparisons

Premier HQI Demonstration Project Participants

Preliminary Data

100.00%

90.00%

85.81%

83.08%

77.97%

80.00%

75.00%

70.00%

65.79%

64.27%

60.47%

60.00%

51.61%

Pre-Release

Rate

50.00%

4Q03

38.10%

40.00%

32.19%

30.00%

20.00%

10.00%

0.00%

Discharge instructions

LVF assessment

ACEI for LVSD

Adult smoking

Composite Quality

cessation counseling

Score

Measure

Alexander 2004

slide13

Composite Score: All 34 HQI Project Measures

HQI Project Time Period: 4Q03 vs 4Q03 - 1Q04

100%

87.2%

90%

86.5%

84.1%

83.0%

78.3%

76.9%

80%

71.3%

69.7%

66.6%

70%

65.4%

60%

50%

Composite Score

40%

30%

20%

10%

0%

Top

2nd

Median

8th

Bottom

Decile Threshold

Alexander 2004