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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
HCQ P
MEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAM
NUMBER OF OBSERVATIONS
Pursuing Excellence
1998-1999
2000-2001
2024-2025
(Projection)
0%
100%
LEVEL OF PERFORMANCE
WHAT WE CAN DO TO IMPROVE QUALITY
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MANAGE PROCESS IN PARTNERSHIP
WITH STAKEHOLDERS
SELECT PRIORITY AREAS
ADOPT OR DEVELOP MEASURES
COLLECT & ANALYZE DATA
IDENTIFY IMPROVEMENT OPPORTUNITIES AND
SELECT APPROPRIATE IMPROVEMENT INTERVENTIONS
GIVE
GIVE
PROMOTE
CONSUMERS STRUCTURE
PLANS,
OR CREATE
INFORCOVERAGE
SUPPORT
DOCTORS
COLLABORAMATION
AND
STANDARD
&
PAYMENTS
AND
TIONS AND
METHODS
PROVIDERS ASSISTANCE TO IMPROVE
PARTNERTECHNICAL
CARE
TO MAKE
SHIPS
ASSISTANCE
CHOICES
REWARD
DESIRED
PERFORMANCE
ESTABLISH
&
ENFORCE
STANDARDS
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CMS 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
HCQ P
MEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAM
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A focus on consumer information,
complemented by additional tactics
GIVE
GIVE
PROMOTE
CONSUMERS
PLANS,
OR CREATE
INFORSUPPORT
DOCTORS
COLLABORAMATION
STANDARD
&
AND
TIONS AND
METHODS
PROVIDERS ASSISTANCE
PARTNERTECHNICAL
TO MAKE
SHIPS
ASSISTANCE
CHOICES
REWARD
DESIRED
PERFORMANCE
HCQ P
MEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAM
STRUCTURE
COVERAGE ESTABLISH
AND
&
PAYMENTS
ENFORCE
TO IMPROVE STANDARDS
CARE
Comparative Quality Information on
www.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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MEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAM
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The National Voluntary Hospital
Reporting 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
HCQ P
MEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAM
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The National Voluntary Hospital
Reporting 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
HCQ P
MEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAM
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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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MEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAM
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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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MEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAM
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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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MEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAM
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One possible payment scenario
Condition X
Condition X
Payment
Adjustment
Threshold
2nd Decile Hospital
1st Decile
3rd Decile
2nd Decile
4th Decile
1st Decile
3rd Decile
5th Decile
2nd Decile
4th Decile
6th Decile
3rd Decile
5th Decile
7th Decile
4th Decile
6th Decile
8th Decile
5th Decile
7th Decile
9th Decile
6th Decile
8th Decile
7th Decile
9th Decile
Condition X
Top
Performance
Threshold
1st Decile
8th Decile
10th Decile
10th Decile
9th Decile
10th Decile
Year One
Year Two
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MEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAM
Year Three
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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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MEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAM
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Doctor’s Office Quality (DOQ)
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: 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 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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MEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAM
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DOQ-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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MEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAM
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More 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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MEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAM
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Thank you
Barbara R. Paul MD
410-786-5629
bpaul@cms.hhs.gov
HCQ P
MEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAM