Public Reporting of Quality in
Healthcare:
The Power of Transparency
Alliance for Health Reform Briefing
April 27, 2011
Gerry Shea, AFL-CIO
Impact of Public
Reporting
• Major Performance
Improvement in Hospitals
• First Major Role for
Purchasers
• Promise of Consumer
Engagement
Rapid Advance of Quality Measurement & Reporting
Medicare
Modernization
Act of 2003
Legislation
Deficit
Reduction
Act of 2005
Medicare
Improvements for
Patients &
Providers Act of
2008
Tax Relief &
Healthcare Act
of 2006
Public-Private
Efforts
NCQA Quality
Compass (public
reporting of
health plan data)
Health plan
measures
launched
with HEDIS
1.0
Hospital
Compare
website
launched
AMA PCPI*
established
National Quality
Forum
established
Patient
Experience
data posted
on Hospital
Compare
HQA*
established
AQA*
established
CAHPS
tool
1989-1998
1999
Presidential
Commission
Report on
Quality
IOM “To
Err is
Human”
2000
2001
2002
IOM
“Crossing the
Quality
Chasm”
PCPI – Physician Consortium for Performance Improvement
HQA – Hospital Quality Alliance
AQA – Ambulatory Quality Alliance
AHIC – America’s Health Information Community
QASC – Quality Alliance Steering Committee
VBP – Value-Based Purchasing
SFQ – Stand for Quality
ACO – Accountable Care Organization
2003-04
AHRQ
National
Healthcare
Quality and
Disparities
Reports
Medicare 2%
hospital incentive
for reporting
performance
measures
Mortality
data posted
on Hospital
AHIC*
Compare
established
2005
IOM Report:
Performance
Measurement
Accelerating
Improvement
2006
2007
IOM Report: CMS VBP
Rewarding
Plan to
Provider
Congress
Performance
The Patient
Protection &
Affordable
Care Act of
2010
PreRulemaking
Consultative
Process
Launched
(The MAP)
Release of
NPP
Priorities
& Goals
National
Quality
VBP/ACO*
Readmissions Strategy rules released
data posted on Released
Hospital
Compare
EHR MU
QASC* all
reporting
payer data
SFQ*
begins
aggregation launched
Physician
voluntary
reporting
begins
(PQRS)
2008
2009
2010-11
Hospital Measurement:
Then & Now --- 2000-2011
Hospitals Today
Few measures
across relevant
areas
Many measures -too many or not the
right ones?
National strategy/national priorities to
improve: Delivery of health care services,
outcomes, population health
Industry resistance
Willing participation
Interagency Working Group on Health
Care Quality; multi-stakeholder input
No uniform data
collection
Increasing
standardized data
collection and
reporting
Secretary to establish and implement
overall framework public reporting;
defined steps between measure
identification and public reporting
Little improvement
driven by measures
Major improvement
Use performance measures to track
quality, form the basis of payment
incentives or reductions, and help the
public make informed choices
No experience with
measure use
Wealth of
experience with
measure use
AHRQ new authority to identify, develop,
evaluate, and disseminate innovative
strategies for QI practices
© Copyright, The Joint Commission
ACA – Going
Forward
PPACA
Hospitals - 2000
© Copyright, The Joint Commission
Vast Improvement On Composite of
Most Powerful Measures
© Copyright, The Joint Commission
Improvement By Clinical Area
Impact of Public Reporting “Partnership for Patients:
Better Care, Lower Costs”
1.
2.
Reduce harm caused to patients in hospitals. By the end of 2013, preventable
hospital-acquired conditions would decrease by 40%.
Achieving this goal would mean some 1.8 million fewer injuries
to patients with more than 60,000 lives saved over three years.
Improve care transitions. By the end of 2013, preventable complications during a
transition from one care setting to another would be decreased such that all
hospital readmissions would be reduced by 20% compared to 2010.
Achieving this would mean more than 1.6 million patients would recover
from illness without suffering a preventable complication requiring re-hospitalization
within 30 days of discharge.
Potential to save up to $35 billion dollars over three years.
Medicare Value-Based Purchasing
Policy
2011
2012
2013
2014
2015
2016
2017
Hospital Inpatient
Quality Reporting
Program /a
-2.0%
-2.0%
-2.0%
-2.0%
-1.0%
-1.0%
-1.0%
Meaningful Use
+
Incentive Payments
/b -
.5%
1.7%
1.7%
1.3%
1.4%
-1.0%
-2.0%
-3.0%
Hospital Acquired
Conditions (Current)
/c
-.02%
-.02%
-.02%
-.02%
-1.0%
-1.0%
-1.0%
-.02%
-.02%
-.02%
Hospital Acquired
Conditions (ACA)
/d
Readmissions /e
-1.0%
-2.0%
-3.0%
-3.0%
-3.0%
Hospital ValueBased
+
Purchasing /f
-
1.0%
- 1.0%
1.25%
- 1.25%
1.5%
- 1.5%
1.75%
- 1.75%
2.0%
- 2.0%
Notes:
• Percentages reflect approximate maximum potential impact to an individual hospital.
• The values in the column labeled “2017” remain constant thereafter.
a. Non-reporting hospitals lose 2% of their annual market basket update through 2014, then lose ¼ of that update from 2015 onwards. The actual
percentage will vary depending on the market basket update each year (-1% is illustrative).
b. Incentive payments approximate CMS Office of the Actuary estimates in the “high adoption” scenario. Payment reductions represent reduction to
annual market basket update by ¼, ½, and ¾ in 2015, 2016, and 2017, respectively for hospitals that have not qualified as meaningful users. The
actual percentage will vary depending on the market basket update each year (-1%, -2%, and -3% are illustrative).
c. HACs reported through claims do not qualify DRG payment for severity adjustment.
d. Requires a 1% cut to those hospitals who rank in the top quartile of occurrences of HACs.
e. Hospitals that do not meet individualized hospital-specific readmissions benchmark face potential cut to up to a percentage ceiling .
f. Percentage of base-DRG payment subject to meeting quality measure requirements. Policy must be budget neutral, so potential for high-achieving
hospitals to earn bonuses depending on the number of non-achieving hospitals.
In Addition to Value-Based Payment
Reform, The Two Major Models of Care
in The ACA Depend on Public Reporting
• Advanced Primary Care Practices,
“Patient-Centered Medical Homes”
(PCMHs)
• New Comprehensive Care Systems,
“Accountable Care Organizations”
(ACOs)
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