Surgery News - March 2008 - (Page 9) MARCH 2008 • SURGERY NEWS THE THE E Alliance Starts 3-Year ‘Quest’ for Quality A new program is readying hospitals for the world of value-based purchasing and pay for performance. B Y M A RY E L L E N S C H N E I D E R 20/20 / 0/20 V SION O SIO SION IO Else vier Global Medical Ne ws ver the next 3 years, more than 100 hospitals will collect quality data on mortality, appropriate care, efficiency, harm avoidance, and patient satisfaction with the aim of improving care and controlling costs. The Quest: High Performing Hospitals project, which was launched by Premier Inc., a hospital performance improvement alliance, is also designed to test performance measures that will likely be included in future pay-forperformance programs. “It’s an opportunity to learn but also to guide the industry,” said Stephanie Alexander, senior vice president and general manager of Premier’s informatics division. In the short term, the program is aimed at preparing hospitals for a world of value-based purchasing and pay for performance. Over the long term, it should help hospitals improve quality and safety while safely reducing costs. “It’s really a laboratory,” said Dr. Richard A. Bankowitz, vice president and medical O director for the informatics division. Premier began recruiting hospitals for the program last summer and in January started collecting quality data. Over the course of the project, Premier will collect data on the following: Mortality, by using a risk-adjusted ratio to measure progress toward the goal of eliminating all avoidable deaths. Evidence-based care, via a measure of the percentage of patients receiving “perfect care” based on nationally recognized quality measures. Efficiency, through a measure of total inpatient cost per case-mix–adjusted discharge, including all of the costs associated with each episode of acute care. Patient experience, as measured using the Centers for Medicare and Medicaid Services’ Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient satisfaction measures. The program will also study how patient satisfaction can relate to cost, quality, and safety. Harm avoidance, via measures of the prevention of health care–associated infections and adverse drug events. Premier is working with the Institute for Healthcare Improvement to develop automated measures of harm that can be reported without having to perform a manual chart review. The first year of the program will focus on mortality, evidence-based care, and efficiency. The hospitals will take on harm avoidance and patient satisfaction during the second year. Premier will analyze the data from each hospital, disseminate best practices among the facilities, and provide financial incentives to the top-performing hospitals at the end of the 3-year project. The amount of the reward pool has yet to be determined; but there are no penalties for hospitals who don’t meet the goals. There was no cost for hospitals to participate, Ms. Alexander said, but they needed to have a commitment at both the executive and board levels to meeting the quality goals. They also had to commit to data collection and sharing best practice knowledge, she said. Premier also encouraged hospitals not to make Quest a “special” project but to incorporate it into their everyday business. “There is a strong commitment by hospitals to join Quest,” Ms. Alexander said. The project builds on the success of the Hospital Quality Incentive Demonstration project, a pay-for-performance initiative performed in collaboration with the Centers for Medicare and Medicaid Services that showed significant improvements in quality and reductions in the cost of care. The Medicare demonstration showed that hospitals can improve both quality and cost and that there is no reason to think the lessons learned can’t be applied beyond the conditions in the pilot project, said Dr. Stephen Schoenbaum, executive vice president for programs at the Commonwealth Fund and a member of the Quest advisory panel. Clinicians and administrators at North Mississippi Health Services in Tupelo didn’t participate in the Medicare demonstration project, but they matched its progress on their own; this time around they were the first to sign up for Quest. It’s obvious that both the government and private payers are moving forward with pay for performance, said Dr. Ken Davis, chief medical officer of North Mississippi Health Services. He and his colleagues want to ensure that when the payers move forward, the measures used are valid, fair, and clinically relevant. “We’d rather be involved and make sure it meets those standards,” Dr. Davis said. While the Quest project is ambitious, he said, these are the areas where payers and patients alike want to see results. ■ but “we’re not done yet,” he said. Improvements are possible regardless of facility size or location, said Dr. Mark Povroznik, director of quality initiatives at United Hospital Center, Clarksburg, W.Va. The 375-bed facility has about 15,000 admissions a year and is facing a large and growing uncompensated care burden, he said at the briefing. The facility has gone from being among the top 20% in two conditions during the first year to being on track to hitting that mark for four conditions in the upcoming year, said Dr. Povroznik. The payout has been tiny, with an estimated $143,000 in bonuses due for 2007, but the rewards are large in quality improvement, he said. For instance, the hospital was struggling to meet a “door-to-balloon” time for acute myocardial infarction. Initially, the hospital was hitting a 2-hour mark for only 71% of cases. Now, 100% of eligible cases are given angioplasty within a recommended 90-minute target, he said. The demonstration project has proved that incentives can work, said Dr. Wynn. CMS is tinkering slightly with the project, however. Starting this year, there will be incentives not just for hospitals showing improvement over baseline and for hitting the top 20%, but also for those that show the greatest improvement. A total of $12 million will be available, he said. ■ pass graft patients was close to 6% at hospitals that met appropriate care benchmarks in only half the patients or P4P Project • from page 1 fewer. Mortality was just under 2% for there has been significant improvement. tals with fewer than eight cases per quar- facilities that met those benchmarks in “Relatively modest dollars can have huge ter were excluded, and all the data were 75%-100% of the patients, he told readjusted using the All Patient Re- porters. impacts,” he said. Huge cultural shifts and large investDr. Evan Benjamin, chief quality offi- fined–Diagnostic Related Groups (APRcer for Baystate Health System in Spring- DRG) methodology created by 3M In- ments in information systems were required to meet the project’s goals, acfield, Mass., agreed that even small fi- formation Systems. Overall, hospitals improved by an av- cording to two hospital executives nancial carrots have an effect. He was the lead author of a study looking at earlier erage 17% on a composite quality score whose facilities participated in the proused by the project. Improvements were ject. Before the project was impledata from the improvement project. mented, the AuroDr. Benjamin and his colleagues found largest in pneura Health Care that quality was higher among the 250 monia and heart FUTURE INCENTIVES WILL BE system was hospitals that were given incentives than failure. Only 70% it was in control hospitals that were re- of patients were GIVEN FOR HOSPITALS SHOWING achieving only incremental quality quired to report their data publicly but receiving approTHE GREATEST IMPROVEMENT, improvement, dewere not given pay-for-performance in- priate pneumonia spite having a culcentives (N. Engl. J. Med. 2007;356:486- care at the start, NOT JUST FOR IMPROVEMENT ture and leaderbut by June 2007, 96). OVER BASELINE. ship focused on There’s room for even more improve- 93% were. For better care, said ment, Dr. Benjamin said at the briefing, heart failure, the Dr. Nick Turkal, rose noting that most of the hospitals started numbers at a relatively high level of quality and from 64% to 93% of patients getting president and CEO of the Milwaukeethat larger financial incentives might quality care. Savings were also greatest based nonprofit system. Participation in the demonstration has for heart failure, at about $1,339 per push greater gains. changed the mind-set to “a pursuit of The Hospital Quality Incentive case. There was a continuing downward perfection,” Dr. Turkal said at the briefDemonstration project began in October 2003; the data released covered every trend in performance variation among ing. The system’s 13 hospitals have the hospitals, with all moving toward the 100,000 admissions annually. Data on quarter through June 2007. Hospitals were given aggregate scores ideal, said Richard Norling, president meeting the pay-for-performance goals for each of five conditions—acute myo- and CEO of Premier Inc. For the hospi- are given to employees every 60 days. cardial infarction, heart failure, coronary tals that were on target 100% of the time The information is also updated reguartery bypass graft, pneumonia, and hip with 100% of patients, costs and mor- larly on the system’s Web site for the and knee replacement—based on re- tality were lowest, he said. For instance, public to see. Mortality and costs are porting for 27 process measures. Hospi- the mortality rate for coronary artery by- down significantly across the system, In Pursuit of Perfection
For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.