Model Hospital Value-Based Purchasing Program Continues to Improve Patient Outcomes

CMS, Premier Healthcare Alliance HQID Project Now Recognizes Participants for Quality Improvement, Performance; Hospitals Continue to Outperform Non-Participants, 225 Receive 1,258 Awards in Year 4 Alone

HQID hospitals have higher quality ratings than national hospitals overall, average 6.9% higher than non-participants (Graphic: Business Wire)

CHARLOTTE, N.C.--()--As policymakers search for models of healthcare payment and delivery reform, fourth year results from the nation’s largest hospital value-based purchasing (VBP) program to improve hospital quality of care show that it is helping patients live longer and receive recommended treatments more frequently.

Hospitals participating in the Centers for Medicare & Medicaid Services (CMS), Premier healthcare alliance Hospital Quality Incentive Demonstration (HQID) VBP project raised their overall quality by an average of 17.2 percent over four years based on their delivery of more than 30 nationally standardized and widely accepted care measures to patients in the five clinical areas.

These improvements saved the lives of an estimated 4,700 heart attack patients in four years, according to a Premier analysis of mortality rates at hospitals participating in the project. The more than 1.5 million patients treated in five clinical areas at the 230 participating hospitals also received approximately 500,000 additional recommended evidence-based clinical quality measures, such as smoking cessation, discharge instructions and pneumococcal vaccination, during that same timeframe.

Additional research by Premier using the Hospital Compare dataset showed that, by March 2008, HQID participants scored on average 6.9 percentage points higher (94.64 percent to 87.36 percent) than non-participants on 19 performance measures used by Hospital Compare, the government’s scorecard for hospital quality.

“The HQID project is the only large-scale hospital value-based purchasing project showing that financial incentives can increase quality of care,” said Charlene Frizzera, acting administrator of CMS. “CMS and Premier have built a substantial body of evidence showing that these types of payment reforms have a direct effect on improving quality and enhancing value.”

The HQID project has served as a basis for CMS’ proposal to Congress for a national VBP or pay-for-performance (P4P) program. The project has also been cited as a test-bed for reform by the Senate Finance Committee as part of healthcare reform.

“The bottom line is that the status quo system of reimbursing hospitals is broken,” said Susan DeVore, Premier president and CEO. “Trying to move the payment system to pay for quality and not solely for volume makes sense, especially when we have substantial evidence to prove that this payment model creates the right incentives to drive continuous improvement.”

New payment model helps drive additional improvements

CMS extended the project for three additional years through September 2009 to test the effectiveness of new incentive models and ways to improve patient care. Beginning with Year 4 results, participants are eligible to receive the following awards:

1) Attainment Award – Hospitals that attain or exceed the median level composite quality score (CQS) benchmark from two years prior will receive an incentive payment.

2) Top Performer Award –The top 20 percent of hospitals in each clinical area will receive an additional incentive payment. This group will receive the Attainment Award as well.

3) Improvement Award – Hospitals that attain median level performance and are among the top 20 percent of hospitals with the largest percentage quality improvements in each clinical area will receive an additional incentive payment.

The new payment model has shown to promote increased quality improvements in the project. Thirteen hospitals moved from the bottom to the top 20 percent of hospitals in one or more clinical areas, improving quality scores by an average 28.1 percentage points over four years.

One of these hospitals with the greatest improvement was St. Vincent Medical Center in Los Angeles, which successfully used the demonstration to drive toward major improvements in the quality of care provided to the patients it serves. St. Vincent received eight overall awards in Year 4, including four for improvement.

According to Cathy Fickes, St. Vincent’s president and CEO, “St. Vincent has always considered quality patient care as our primary goal, which is one of the reasons why we participate in the HQID project. We made it a daily focus to both overcome our initial challenges and to become a top performing hospital in this project and we were able to accomplish that goal. The results of this initiative indicate that our continued efforts as a healthcare team to improve the quality of care we provide our patients are increasingly making us the hospital of choice for our patients, community and those seeking exceptional care.”

Overall, under the project extension’s new reimbursement model, CMS announced that it will award incentive payments of almost $12 million in Year 4 to 225 providers for top performance, as well as top improvement and for reaching a level of attainment, in the project’s five clinical areas. Overall, 1,258 awards were given to these top providers in the fourth year of the project, a five-fold increase from previous years. Through the project’s first four years, CMS has awarded more than $36.5 million to top providers.

Continued DeVore, “The new payment model is based on lessons learned during the first three years of the project and reflects what we expect to see in a national VBP plan. This is the right reform, at the right time, to improve care in the long run.”

About the HQID project

The HQID is the first national project of its kind, designed to determine if economic incentives to hospitals are effective at improving the quality of inpatient care. Hospitals participating in HQID include small/large, urban/rural, and teaching/non-teaching facilities that volunteered to report their quality data for five high-volume inpatient conditions using national measures of quality care. Through the project, Premier collects a set of more than 30 evidence-based clinical quality measures, developed by government and private organizations, from participating hospitals.

“The evidence-based measures used in this project are based on scientific evidence and, for continued effectiveness, are often reviewed to account for medical breakthroughs and new research,” said Richard Bankowitz, MD, MBA, FACP, Premier vice president and medical director. “These measures are tested in care settings, validated by third-parties and proven over time to improve quality.”

The average Composite Quality Scores (CQS), an aggregate of all quality measures within each clinical area, improved significantly between the inception of the program and the end of Year 4 in all five clinical focus areas:

  • From 87.5 percent to 96.3 percent for patients with AMI (heart attack);
  • From 84.8 percent to 98.5 percent for patients with coronary artery bypass graft (CABG);
  • From 64.5 percent to 92.2 percent for patients with heart failure (HF);
  • From 69.3 percent to 92.6 percent for patients with pneumonia (PN);
  • From 84.6 percent to 97.2 percent for patients with hip and knee (HK) replacement.

Top performers

Following are participants receiving the most overall awards in Year 4 with the healthcare system name in parentheses as appropriate. (Providers are eligible to receive a maximum of 10 overall awards.)

Ten awards

  • Aurora Baycare Medical Center; Green Bay, Wis.
  • Bon Secours - Memorial Regional Medical Center; Mechanicsville, Va.
  • Bon Secours - St. Mary’s Hospital; Richmond, Va.
  • White Memorial Medical Center (Adventist Health); Los Angeles

Nine awards

  • Alegent Health - Bergan Mercy Medical Center; Omaha, Neb.
  • Gaston Memorial Hospital (CaroMont Health); Gastonia, N.C.
  • Memorial Regional Hospital (Memorial Healthcare System); Hollywood, Fla.
  • St. Anthony Hospital (SSM Health Care); Oklahoma City
  • St. Helena Hospital (Adventist Health); St. Helena, Calif.
  • Staten Island University Hospital; Staten Island, N.Y.

Eight awards

  • Aurora Sheboygan Memorial Medical Center; Sheboygan, Wis.
  • Citizens Medical Center; Victoria, Texas
  • Duke University Hospital (Duke University Health System); Durham, N.C.
  • Frederick Memorial Hospital (Frederick Memorial Healthcare System); Frederick, Md.
  • Greenville Memorial Hospital (Greenville Health System); Greenville, S.C.
  • Hackensack University Medical Center; Hackensack, N.J.
  • Immanuel Medical Center (Alegent Health); Omaha, Neb.
  • Long Island Jewish Medical Center (North Shore - Long Island Jewish Health System); New Hyde Park, N.Y.
  • Memorial Hospital Pembroke (Memorial Healthcare System); Pembroke Pines, Fla.
  • Mercy Hospital (Alegent Health); Council Bluffs, Iowa
  • Methodist Healthcare Memphis Hospitals (Methodist Healthcare); Memphis, Tenn.
  • North Shore University Hospital (North Shore – Long Island Jewish Health System); Manhasset, N.Y.
  • O’Connor Hospital (Daughters of Charity Health System); San Jose, Calif.
  • Palmetto Health Baptist Columbia (Palmetto Health); Columbia, S.C.
  • Riverside Regional Medical Center (Riverside Health System); Newport News, Va.
  • Rochester General Hospital (Rochester General Health System); Rochester, N.Y.
  • Providence Sacred Heart Medical Center & Children’s Hospital; Spokane, Wash.
  • South Miami Hospital (Baptist Health South Florida); Miami
  • Southeastern Regional Medical Center; Lumberton, N.C.
  • St. Francis Medical Center (Daughters of Charity Health System); Lynwood, Calif.
  • St. Francis Health System (Bon Secours); Greenville, S.C.
  • St. Mary Medical Center (Catholic Healthcare West); Long Beach, Calif.
  • St. Vincent Healthcare (Sisters of Charity of Leavenworth); Billings, Mont.
  • St. Vincent Medical Center (Daughters of Charity Health System); Los Angeles
  • Texas Health Harris Methodist Hospital Cleburne (Texas Health Resources); Cleburne, Texas
  • United Hospital Center; Clarksburg, W.Va.
  • Valley Baptist Medical Center (Valley Baptist Health System); Harlingen, Texas

About Premier Inc., 2006 Malcolm Baldrige National Quality Award recipient

The Premier healthcare alliance is more than 2,200 U.S. hospitals and 63,000-plus other healthcare sites working together to improve healthcare quality and affordability. Premier maintains the nation's most comprehensive repository of clinical, financial and outcomes information and operates a leading healthcare purchasing network. A world leader in helping deliver measurable improvements in care, Premier works with the Centers for Medicare & Medicaid Services and the United Kingdom's National Health Service North West to improve hospital performance. Premier has offices in San Diego, Charlotte, N.C., Philadelphia and Washington.

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Contacts

Premier Inc.
Alven Weil, 704-733-5797
alven_weil@premierinc.com

Contacts

Premier Inc.
Alven Weil, 704-733-5797
alven_weil@premierinc.com