Overview of Today’s Presentation
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HCQ P MEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAM MEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAM 1 1 Overview of Today’s Overview of Today’s Presentation Presentation • Strategies available to CMS to improve quality • Focus on public reporting and consumer information • Current Quality Initiatives, with focus on Hospital work
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Overview of Today’s Presentation. Strategies available to CMS to improve quality Focus on public reporting and consumer information Current Quality Initiatives, with focus on Hospital work. Pursuing Excellence. WHAT WE CAN DO TO IMPROVE QUALITY. MANAGE PROCESS IN PARTNERSHIP - PowerPoint PPT Presentation
Transcript of Overview of Today’s Presentation
HCQ PMEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAMMEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAM
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Overview of Today’s PresentationOverview of Today’s Presentation
• Strategies available to CMS to improve quality
• Focus on public reporting and consumer information
• Current Quality Initiatives, with focus on Hospital work
0% 100%
LEVEL OF PERFORMANCE
NU
MB
ER
OF
OB
SE
RVA
TIO
NS
1998-1999
2000-2001
2024-2025(Projection)
Pursuing ExcellencePursuing Excellence
33WHAT WE CAN DO TO IMPROVE QUALITY
IDENTIFY IMPROVEMENT OPPORTUNITIES AND SELECT APPROPRIATE IMPROVEMENT INTERVENTIONS
ADOPT OR DEVELOP MEASURES
COLLECT & ANALYZE DATA
SELECT PRIORITY AREAS
MANAGE PROCESS IN PARTNERSHIP WITH STAKEHOLDERS
ESTABLISH&
ENFORCE STANDARDS
STRUCTURE COVERAGE
AND PAYMENTS TO IMPROVE
CARE
SUPPORT STANDARD METHODS
GIVE CONSUMERS
INFOR-MATION
AND ASSISTANCE
TO MAKE CHOICES
PROMOTE OR CREATE
COLLABORA-TIONS ANDPARTNER-
SHIPS
GIVE PLANS,
DOCTORS&
PROVIDERS TECHNICAL
ASSISTANCE
REWARD DESIRED
PERFORM-ANCE
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CMS Approach to QualityCMS Approach to Quality
• Announced November 2001 by Secretary Thompson:– Empower consumers to make more informed
decisions regarding their healthcare– Stimulate / support providers & clinicians to improve
the quality of health care
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A focus on consumer information, A focus on consumer information, complemented by additional tacticscomplemented by additional tactics
ESTABLISH&
ENFORCE STANDARDS
REWARD DESIRED
PERFORM-ANCE
SUPPORT STANDARD METHODS
GIVE CONSUMERS
INFOR-MATION
AND ASSISTANCE
TO MAKE CHOICES
PROMOTE OR CREATE
COLLABORA-TIONS ANDPARTNER-
SHIPS
GIVE PLANS,
DOCTORS&
PROVIDERS TECHNICALASSISTANCE
STRUCTURE COVERAGE
AND PAYMENTS
TO IMPROVE CARE
HCQ PMEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAMMEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAM
66Comparative Quality Information on Comparative Quality Information on www.medicare.govwww.medicare.gov
• Medicare Health Plan Compare - 1999
• Dialysis Facility Compare - 2001
• Nursing Home Compare - 2002
• Home Health Compare – 2003
• Hospital Compare – 2004
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The National Voluntary Hospital The National Voluntary Hospital Reporting InitiativeReporting Initiative
• A partnership– American Hospital Association, Federation of
American Hospitals, Assoc of American Medical Centers, The Disclosure Group (consumer, union and private purchaser advocates), National Quality Forum, JCAHO, American Medical Association, Nat Assoc of Hosp for Children and Related Inst, Agency for Healthcare Research and Quality, AFL-CIO
• Public reporting and building of a data infrastructure simultaneously
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The National Voluntary Hospital The National Voluntary Hospital Reporting InitiativeReporting Initiative
– Phase I: report starter set of 10 measures (NOW in progress)
– Phase II: report standardized patient perception of care survey (HCAHPS) (late 2004 at earliest)
– Phase III: more measures
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The Premier Hospital Quality Incentive Demonstration
• A demo is a way for CMS to send a new message, to test new payment methods
• This demo: Test how/if financial incentives drive superior quality inpatient care
• CMS demonstration with Premier, Inc.• Reports the performance data on
www.cms.hhs.gov
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The Premier Hospital Quality Incentive Demonstration
5 clinical conditions (34 measures)– Acute MI
– Heart Failure
– Pneumonia
– Coronary Artery Bypass Graft
– Hip and Knee Replacement
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The Premier Hospital Quality Incentive Demonstration
• Top 50% of hospitals in each clinical area publicly acknowledged on CMS website
• Bonuses for top 2 deciles for each condition– Top decile given 2% bonus of their Medicare
DRG payments for that condition– Second decile given a 1% bonus
• Possible penalty in third year for laggards
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One possible payment scenarioOne possible payment scenario
1st Decile
Hospital 2
Condition X
Condition X
Condition X
Top Performance Threshold
Payment Adjustment Threshold
2nd Decile
3rd Decile
4th Decile
5th Decile
6th Decile
7th Decile
8th Decile
9th Decile
10th Decile
Year One Year Two Year Three
1st Decile
2nd Decile
3rd Decile
4th Decile
5th Decile
6th Decile
7th Decile
8th Decile
9th Decile
10th Decile
1st Decile
2nd Decile
3rd Decile
4th Decile
5th Decile
6th Decile
7th Decile
8th Decile
9th Decile
10th Decile
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The Premier Hospital Quality Incentive Demonstration
• Voluntary
• Eligibility: Hospitals in Premier Perspective system as of March 31, 2003
• 300 hospitals anticipated to participate
• Demonstration Project: test of concept
• Could be expanded (with modifications) in the future
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Doctor’s Office Quality (DOQ) Doctor’s Office Quality (DOQ) Project (early stages now)Project (early stages now)
• Topics: Preventive care, DM, HTN, CAD, HF, Osteoarthritis, Depression, patient perceptions of care, assessment of systems of care.
• Clinical measures– Developed in conjunction with AMA/Consortium and
with expert panel
– Exploring ability to create composite score
– Exploring use of claims-based data, EHRs.
• Process improvements– Care reminders, other
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DOQ-IT: ObjectivesDOQ-IT: Objectives
• Promote adoption and use of IT in physician offices
• Create infrastructure for QIO to receive data from electronic office-based systems for use in confidential technical assistance and public reporting
Just starting this – completing some early contracting
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DOQ-IT: What QIOs will doDOQ-IT: What QIOs will do
• Assist physicians in decision to adopt– Costs and benefits– Systems availability – registry/EHR – Systems information
• Provide implementation assistance– Technical issues– Workflow redesign
• Receive electronic data from physicians and provide improvement assistance– EHR specifications for clinical measures and systems
operating reports– Process redesign to support chronic care management
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DOQ-IT: Potential DemonstrationDOQ-IT: Potential Demonstration
• Requirements for payment– Adopt specified IT systems to improve safety/quality
and to manage patients with chronic disease» Full EHR or
» E-Rx, e-lab results management, e-registry
– Demonstrate use of such systems through electronic data transmitted to QIO
– Meet performance targets – public reporting
– Meet cost reduction targets (in aggregate)
• Coordination with Bridges to Excellence program
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More InformationMore Information
• http://www.cms.hhs.gov/quality/
Fact sheets on: Hospital Quality Initiative; 3 State Hospital Pilot; H-CAHPS; Nursing Home and Home Health Quality Initiatives, more
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Thank youThank you
Barbara R. Paul MD
410-786-5629
