Quality Incentives Show Positive Results at Year 3

Hospitals participating in year 3 of the Premier Hospital Quality Incentive Demonstration program raised quality scores across all measured areas by an average of 15.8%, with the greatest improvements in treatment of pneumonia and heart failure patients, according to the Centers for Medicare and Medicaid Services.

The Hospital Quality Incentive Demonstration (HQID), which began in 2003, measures what percentage of patients at 250 participating hospitals are getting appropriate care in five areas: heart attack, heart failure, pneumonia, coronary artery bypass graft, and hip and knee replacements. CMS awards bonuses based on the performance and improvement measures.

Data used for the program were collected by Premier, a network of not-for-profit hospitals. According to CMS and Premier, since the program's inception, gains have been made in percentage of patients receiving adequate care in all five of the measured areas. CMS reported that a total of 96% of heart attack patients at participating hospitals received adequate care in 2006, compared with 87% at baseline, according to the Premier measure. Similarly, 97% of coronary artery bypass graft patients, up from 85% 3 years ago, got adequate care.

The data from year 3 of the program also showed that 89% of heart failure patients, compared with 64% in 2003, received appropriate treatment, and among pneumonia patients, 90%, versus 69% 3 years ago, received quality care. A total of 97% of hip and knee replacement patients, compared with 85% in 2003, received proper care according to the measures.

Premier reported that hospitals in the top 10% in each area receive a bonus payment of 2% of the Diagnosis Related Group-based prospective payment for the patients with the measured condition for all Medicare fee-for-service beneficiaries. Hospitals in the next highest 10% receive a 1% payment. Facilities in the top 50% of each area receive recognition on the CMS Web site (the complete list is at www.cms.hhs.gov/HospitalQualityInits/35_HospitalPremier.asp

Dr. Franklin Michota, of the department of hospital medicine at the Cleveland Clinic, said the HQID program is a useful tool to motivate even individual physicians. “That 1%-2% Medicare reimbursement update could be huge for the hospital's bottom line, which could affect lots of things in [the physician's] world. It could affect ancillary support, or your office space.”

But the program is not without problems. For example, Dr. Michota said, data on when to give antibiotics in pneumonia patients— part of the quality measures for treatment of pneumonia patients—is being challenged in the current literature. “It's not clear that [administering timed antibiotics] is consistently and reliably linked to mortality, and the adverse effect might be treating too many people with antibiotics who don't have pneumonia.”

Dr. Michota added that other areas where hospitalists can expect to see process-based quality measures like these enacted in the future include treatment for deep vein thrombosis, the use of anticoagulants, and checking the immunization status of incoming patients.

Hospitals participating in year 3 of the Premier Hospital Quality Incentive Demonstration program raised quality scores across all measured areas by an average of 15.8%, with the greatest improvements in treatment of pneumonia and heart failure patients, according to the Centers for Medicare and Medicaid Services.

The Hospital Quality Incentive Demonstration (HQID), which began in 2003, measures what percentage of patients at 250 participating hospitals are getting appropriate care in five areas: heart attack, heart failure, pneumonia, coronary artery bypass graft, and hip and knee replacements. CMS awards bonuses based on the performance and improvement measures.

Data used for the program were collected by Premier, a network of not-for-profit hospitals. According to CMS and Premier, since the program's inception, gains have been made in percentage of patients receiving adequate care in all five of the measured areas. CMS reported that a total of 96% of heart attack patients at participating hospitals received adequate care in 2006, compared with 87% at baseline, according to the Premier measure. Similarly, 97% of coronary artery bypass graft patients, up from 85% 3 years ago, got adequate care.

The data from year 3 of the program also showed that 89% of heart failure patients, compared with 64% in 2003, received appropriate treatment, and among pneumonia patients, 90%, versus 69% 3 years ago, received quality care. A total of 97% of hip and knee replacement patients, compared with 85% in 2003, received proper care according to the measures.

Premier reported that hospitals in the top 10% in each area receive a bonus payment of 2% of the Diagnosis Related Group-based prospective payment for the patients with the measured condition for all Medicare fee-for-service beneficiaries. Hospitals in the next highest 10% receive a 1% payment. Facilities in the top 50% of each area receive recognition on the CMS Web site (the complete list is at www.cms.hhs.gov/HospitalQualityInits/35_HospitalPremier.asp

Dr. Franklin Michota, of the department of hospital medicine at the Cleveland Clinic, said the HQID program is a useful tool to motivate even individual physicians. “That 1%-2% Medicare reimbursement update could be huge for the hospital's bottom line, which could affect lots of things in [the physician's] world. It could affect ancillary support, or your office space.”

But the program is not without problems. For example, Dr. Michota said, data on when to give antibiotics in pneumonia patients— part of the quality measures for treatment of pneumonia patients—is being challenged in the current literature. “It's not clear that [administering timed antibiotics] is consistently and reliably linked to mortality, and the adverse effect might be treating too many people with antibiotics who don't have pneumonia.”

Dr. Michota added that other areas where hospitalists can expect to see process-based quality measures like these enacted in the future include treatment for deep vein thrombosis, the use of anticoagulants, and checking the immunization status of incoming patients.

Hospitals participating in year 3 of the Premier Hospital Quality Incentive Demonstration program raised quality scores across all measured areas by an average of 15.8%, with the greatest improvements in treatment of pneumonia and heart failure patients, according to the Centers for Medicare and Medicaid Services.

The Hospital Quality Incentive Demonstration (HQID), which began in 2003, measures what percentage of patients at 250 participating hospitals are getting appropriate care in five areas: heart attack, heart failure, pneumonia, coronary artery bypass graft, and hip and knee replacements. CMS awards bonuses based on the performance and improvement measures.

Data used for the program were collected by Premier, a network of not-for-profit hospitals. According to CMS and Premier, since the program's inception, gains have been made in percentage of patients receiving adequate care in all five of the measured areas. CMS reported that a total of 96% of heart attack patients at participating hospitals received adequate care in 2006, compared with 87% at baseline, according to the Premier measure. Similarly, 97% of coronary artery bypass graft patients, up from 85% 3 years ago, got adequate care.

The data from year 3 of the program also showed that 89% of heart failure patients, compared with 64% in 2003, received appropriate treatment, and among pneumonia patients, 90%, versus 69% 3 years ago, received quality care. A total of 97% of hip and knee replacement patients, compared with 85% in 2003, received proper care according to the measures.

Premier reported that hospitals in the top 10% in each area receive a bonus payment of 2% of the Diagnosis Related Group-based prospective payment for the patients with the measured condition for all Medicare fee-for-service beneficiaries. Hospitals in the next highest 10% receive a 1% payment. Facilities in the top 50% of each area receive recognition on the CMS Web site (the complete list is at www.cms.hhs.gov/HospitalQualityInits/35_HospitalPremier.asp

Dr. Franklin Michota, of the department of hospital medicine at the Cleveland Clinic, said the HQID program is a useful tool to motivate even individual physicians. “That 1%-2% Medicare reimbursement update could be huge for the hospital's bottom line, which could affect lots of things in [the physician's] world. It could affect ancillary support, or your office space.”

But the program is not without problems. For example, Dr. Michota said, data on when to give antibiotics in pneumonia patients— part of the quality measures for treatment of pneumonia patients—is being challenged in the current literature. “It's not clear that [administering timed antibiotics] is consistently and reliably linked to mortality, and the adverse effect might be treating too many people with antibiotics who don't have pneumonia.”

Dr. Michota added that other areas where hospitalists can expect to see process-based quality measures like these enacted in the future include treatment for deep vein thrombosis, the use of anticoagulants, and checking the immunization status of incoming patients.