February 21, 2007
No matter the size of your organization, delivering health care today means processing and analyzing huge volumes of data, and turning those data into usable information. What this information conveys about your hospital is more important than ever, because it will be used as a key source for comparison when evaluating the marketplace and is increasingly important in determining level of payment. This excerpt from A Hospital's Tale, an HFMA educational report sponsored by 3M Health Information Systems, summarizes some key quality data reporting initiatives and pay-for-performance initiatives.
Major Data Reporting Initiatives
Medicare Hospital Compare
The Medicare Modernization Act, or MMA, called for a full Medicare update to be granted only to those hospitals that report to CMS the results of certain measures of hospital performance (hospitals in 2007 need to report 21 measures or face a 2 percent penalty). These measures are reported online to the public at CMS's Hospital Compare. Not surprisingly, nearly all hospitals now report on all of these measures, rather than suffer the financial penalty for failing to report.
Hospital Quality Alliance
HQA, a coalition of provider, purchaser, consumer, and other groups, is working to expand the number of measures to be publicly reported. These include HCAHPS, a 27-item survey of consumers' perceptions of the care they receive. Hospitals have been testing HCAHPS, and this survey will debut for purposes of public reporting in 2007. Other measures of care are being added to the HQA framework as well. These include post-discharge mortality rates for heart attack, heart failure, and pneumonia; measures of post-surgery blood clot prevention; measures of processes of care to prevent surgical infections and ventilator-assisted pneumonia; and measures of the rate of infections in hospital intensive care units associated with catheters, intravenous lines, and ventilator use.
AQA Alliance
A related national initiative is the AQA alliance (formerly the Ambulatory Care Quality Alliance), focusing on measuring areas of physician practice. This effort, similar in structure to the HQA but broader in scope, has approved nearly 50 measures of performance addressing ambulatory care, cardiology, and cardiac surgery. Pilot data-collection projects are under way, although no AQA reporting is currently tied to payment.
Major Pay-for-Performance Initiatives
Integrating clinical and financial performance, pay-for-performance programs award higher reimbursement to providers who score higher than peers on a given set of performance measures. Congress and CMS have been considering ways to enact pay-fo-performance broadly through Medicare, although the debate on how to set up a rewards-and-punishment system and the proper measures of performance have not been settled. Even so, the concept of pay-for-performance is gaining wide acceptance, thanks to a variety of experiments. More than 100 pay-for-performance experiments and initiatives are currently in place. Here are a few of the biggest:
Bridges to Excellence
This multi-state, multiple-employer initiative rewards physicians. Charter employers include General Electric, UPS, Procter & Gamble, and Verizon—all of which offer bonus payments to physicians. Participants include the National Business Coalition on Health, National Committee for Quality Assurance, MEDSTAT, and WebMD Health. The NCQA selects which physicians qualify for awards based on evaluating and verifying their data. Rewards vary; for instance, physicians meeting the necessary thresholds will receive a yearly bonus of $80 for each of their diabetic patients covered by one of the participating employers.
CMS/Premier Hospital Quality Incentive Demonstration Project
This three-year project was launched in 2003 to provide financial rewards and public recognition to hospitals that demonstrate high-quality performance in a number of areas of acute care. For each clinical area, hospitals in the top decile receive a 2 percent quality incentive payment on their base Medicare DRG payment for the relevant clinical condition(s); those in the second decile will receive a 1 percent quality incentive payment.
Integrated Healthcare Association
Unveiled in 2002, the IHA initiative is a collaborative of six health plans in California that rewards physician groups for clinical achievements, information technology, and patient satisfaction. Common performance measures are used, but each plan uses the results to design its own bonus program.
SOURCE: A Hospital's Tale: HFMA Resource Library
Additional Resources:
Education
HFMA Audio Webcast Recordings
If you have questions or comments about HFMA Wants You to Know, contact editor Maxine Harrison.
HFMA Wants You to Know ISSN: 1540-0697. Volume VI, Issue 4. Copyright 2007, Healthcare Financial Management Association. All rights reserved.