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CMS-Premier Hospital Quality Incentive Demonstration Project

CMS-Premier Hospital Quality Incentive Demonstration Project . Stephanie Alexander Senior Vice President Premier Inc. Healthcare Informatics www.qualitydemo.com. About Premier.

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CMS-Premier Hospital Quality Incentive Demonstration Project

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  1. CMS-Premier Hospital Quality Incentive Demonstration Project Stephanie Alexander Senior Vice President Premier Inc. Healthcare Informatics www.qualitydemo.com Alexander 2004

  2. About Premier • Premier, Inc., is a strategic alliance owned by 200 of the United States’ leading not-for-profit hospitals and healthcare systems. • These systems operate or are affiliated with nearly 1,500 hospitals and hundreds of other healthcare sites. Owners Affiliates Alexander 2004

  3. Is there a business case for quality in hospitals? Performance Group Hospitals Innovation Group Opportunity Group Top Performers Lowest Performance Top decile in performance (low cost and high quality) Bottom quartile in performance (high cost, low quality) Alexander 2004

  4. CABG Performance Source: Premier PerspectiveTM Alexander 2004

  5. Non-collaborators’ financial performance Source: Premier PerspectiveTM Alexander 2004

  6. Collaborators’ financial performance Source: Premier PerspectiveTM Alexander 2004

  7. CMS/Premier Hospital QualityIncentive Demonstration Project • A three-year effort linking payment with quality measures • Top performers identified in five clinical areas • Acute Myocardial Infarction • Congestive Heart Failure • Coronary Artery Bypass Graft • Hip and Knee Replacement • Pneumonia • 278 participating hospitals nationwide Alexander 2004

  8. Identifying Top Performers • Composite Quality Index will identify hospitals performing in the top two deciles in each clinical focus group • Composed of two components: • Composite Process Rate • Risk-Adjusted Outcomes Index • Clinical conditions without outcomes indicators use only the Composite Process Rate Alexander 2004

  9. Widely accepted quality measures The CMS/Premier quality measures are based on clinical evidence and industry recognized metrics, including: • All 10 indicators from the National Voluntary Hospital Public Reporting Initiative • 27 indicators from the National Quality Forum (NQF). • 24 indicators from CMS 7th Scope of Work. • 15 indicators from JCAHO Core Measures. • 3 indicators proposed by The Leapfrog Group. • 4 indicators from the Agency for Healthcare Research and Quality’s (AHRQ) patient safety indicators. Alexander 2004

  10. Medicare Payment Incentives • Incentive payment threshold changes annually for each clinical condition • Top decile performers in a given clinical area receive a 2 percent payment supplement per condition • Second decile performers receive a 1 percent payment supplement per condition. • Reduced payments in year 3: • 1% reduction if < year one ninth decile • 2% reduction if < year one tenth decile Alexander 2004

  11. Condition X Condition X Condition X 1st Decile 2nd Decile 1st Decile 3rd Decile Hospital 4th Decile 1st Decile 2nd Decile Top Performance Threshold 5th Decile 3rd Decile 6th Decile 2nd Decile 4th Decile 7th Decile 5th Decile 8th Decile 3rd Decile 9th Decile 6th Decile 4th Decile 10th Decile 7th Decile Hospital 5th Decile 8th Decile 9th Decile 6th Decile 10th Decile 7th Decile Payment Adjustment Threshold Hospital 8th Decile 9th Decile 10th Decile Year One Year Two Year Three Anticipated payment scenario Alexander 2004

  12. Heart Failure: Pre-release vs 4Q03 Median Comparisons Premier HQI Demonstration Project Participants Preliminary Data 100.00% 90.00% 85.81% 83.08% 77.97% 80.00% 75.00% 70.00% 65.79% 64.27% 60.47% 60.00% 51.61% Pre-Release Rate 50.00% 4Q03 38.10% 40.00% 32.19% 30.00% 20.00% 10.00% 0.00% Discharge instructions LVF assessment ACEI for LVSD Adult smoking Composite Quality cessation counseling Score Measure Alexander 2004

  13. Composite Score: All 34 HQI Project Measures HQI Project Time Period: 4Q03 vs 4Q03 - 1Q04 100% 87.2% 90% 86.5% 84.1% 83.0% 78.3% 76.9% 80% 71.3% 69.7% 66.6% 70% 65.4% 60% 50% Composite Score 40% 30% 20% 10% 0% Top 2nd Median 8th Bottom Decile Threshold Alexander 2004

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