CMS/Premier Demo Pay for Performance
In 2003,CMS partnered with Premier for the first national pay-for-performance
demonstration for hospitals. Over 260 Premier hospitals volunteered.
Hypothesis
Financial Incentives improve hospital quality performance
Improving Quality Through Systems Change
Findings
National Health Policy Conference, Washington, DC
¾ Focus on Quality - The P4P Program financial incentives did focus hospital executive attention
on measuring quality and refining care processes according to the study infrastructure.
Stephanie Alexander, Sr. VP,
Premier Healthcare Informatics
February 12, 2007
¾ Premier is the Change Agent - The Premier Infrastructure and measurements were actually
the change agents in focusing quality improvement efforts. The more hospitals were monitored,
the better performance improved over time.
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HQID Year 2 – Final Results
Dramatic Improvement Continues
Released January 26, 2007
Composite Quality Score
CMS/Premier HQID Project Participants Composite Quality Score:
Trend of Quarterly Median (5th Decile) by Clinical Focus Area
• Quality improvement across all
hospitals and clinical areas
October 1, 2003 - June 30, 2006 (Year 1 and Year 2 Final Data, and Yr 3 YTD Preliminary)
• HQID raised overall quality by
11.8% in 2 years
105%
75%
70%
• Premier P4P hospitals quality
scores are higher than national
average – 85% compared to
79%
65%
60%
AMI
CABG
85.13%
86.69%
88.68%
90.93%
91.63%
93.40%
95.20%
95.92%
96.05%
96.89%
97.50%
73.05%
76.14%
78.22%
81.57%
82.98%
84.38%
86.73%
88.79%
90.00%
80%
63.96%
68.11%
85%
78.07%
80.00%
82.49%
82.72%
84.81%
86.30%
88.54%
89.28%
90.09%
• Patients received ~150,000
add’l treatments
90%
70.00%
73.06%
• AMI improvements saved 1,284
AMI patients
85.14%
85.92%
89.45%
90.57%
93.70%
94.89%
96.16%
97.01%
96.77%
98.28%
98.44%
Composite Quality Score
95%
89.62%
89.95%
91.50%
92.55%
93.50%
93.36%
95.08%
95.77%
95.98%
96.14%
96.84%
100%
• Quality incentive payments of
$8.7 Million paid to 115
hospitals
Pneumonia
Heart Failure
Hip and Knee
Clinical Focus Area
4Q03
1Q04
2Q04
3Q04
4Q04
1Q05
2Q05
3Q05
4Q05
1Q06
2Q06
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Example of decile movement (by year)
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Why such movement in quality?
• Not just “one” reason - a combination
• National alignment of evidence-based quality
measures
• Transparency (public reporting)
• Rewards for improvement
• Leadership
• System-level change
Building a Quality Culture
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1
Top Performer Characteristics
Premier Performance Pays Study
• “Quality” core value of institution
Premier’s Performance Pays study proves that when evidence-based processes are
delivered, quality is higher and costs are lower. First study of its kind over 400,000
patient discharges studied.
• Priority of executive team
• Physician engagement
• Improvement methodology
• Prioritization methodology
• Dedicated resources
• Committed “knowledge transfer”
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Increased process reliability results
in fewer complications
Increased process reliability results in lower costs
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Shorter Length of Stay
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Fewer Readmissions
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Improvement Opportunity
Example:
Composite Quality Score
Hip and Knee Surgery, and AMI Patients
in One Year Alone
Heart Failure
100%
95%
90%
88%
80%
70%
75%
60%
50%
Q4 03
$1.4 Billion
Q4 04
Composite Quality Score
Acute Myocardial Infarction
For Pneumonia, Heart Bypass Surgery,
100%
95%
90%
80%
70%
72%
60%
53%
50%
Q4 03
Q4 05
Composite Quality Score
6,000 Avoidable Deaths
6,000 Complications
10,000 Readmissions
800,000 Days
100%
96%
90%
97%
80%
70%
60%
66%
50%
Q4 03
Q4 04
Q4 04
Q4 05
Pneumonia
Composite Quality Score
Hip and Knee
100%
90%
89%
80%
79%
70%
68%
60%
50%
Q4 05
Q4 03
Q4 04
Q4 05
Quality a core value, executive priority, physician engagement, improvement methodology,
prioritization methodology, dedicated resources, committed knowledge transfer
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Example: Health System Improvement
Why such movement in quality?
• A decision to
participate as a
system
• A proxy for system
connectivity
• A few surprises . .
• And the most
important decision
we’ve made for
cultural
advancement
around quality
• Not just “one” reason - a combination
• National alignment of evidence-based quality
measures
• Transparency (public reporting)
• Rewards for improvement
• Leadership
• System-level change
Building a Quality Culture
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