Premier Hospital Quality Incentive Demonstration

• Abstract
• Purpose of health policy or idea
• Characteristics of this policy
• Political and economic background
• Purpose and process analysis
• Expected outcome
• References

Abstract

The Premier Hospital Quality Incentive Demonstration examines whether hospital quality of care can be improved through awarding bonuses to more than 250 hospitals in a variety of clinical areas, and allowing public access of hospital performance to consumers by publishing the data and reports on the Centers for Medicare and Medicaid Services (CMS) website. Monetary incentives are provided to hospitals based on the quality score given at the end of each year.

Purpose of health policy or idea

An estimated 100000 people die unnecessarily in hospitals every year. The main objective of this demonstration is to significantly improve the quality of care patients receive in hospitals in the following areas:

• Acute Myocardial Infarction (AMI)
• Coronary Artery Bypass Craft (CABC)
• Heart Failure (HF)
• Community Acquired Pneumonia (CAP)
• Hip and Knee Replacement

The score hospitals receive are based upon evaluation and evidence-based data. The results are then published on the Centers for Medicare and Medicaid Services (CMS) website (www.cms.hhs.gov/HospitalQualityInits/35_HospitalPremier.asp#TopOfPage) to increase awareness to the public of the performance of hospitals.

Main points

Main objectives

The Premier Hospital Quality Incentive Demonstation objective is to evaluate if the quality of inpatient hospital care improves by awarding payments to hospitals that demonstrate a high quality of care. This is done by computing quality scores for over 250 non-for-profit hospitals and awarding the top hospitals with monetary awards. These scores are published on the CMS website to provide knowledge to the public. This policy could affect patients by significantly improving qualtiy of care that is recieved, hospitals by increasing the overall quality of care that is given, and the public by increasing awareness of hospital performance.

Type of incentives

Incentives to the hospital are based on individual scores. Hospitals in the top 20% are given a monetary reward for their quality care. Hospitals in the first tenth percentile are given a 2% bonus of what is recieved for Medicare patients. Similarly, the second tenth percentile received a bonus of 1%. If hospitals do not achieve quality improvements within three years, they will be fined.

Groups affected

Hospitals, physicians, Medicare program, general public

Innovationsgrad	traditionell		innovativ
Kontroversität	unumstritten		kontrovers
Strukturelle Wirkung	marginal		fundamental
Medienpräsenz	sehr gering		sehr hoch
Übertragbarkeit	sehr systemabhängig		systemneutral

The Premier Hospital Quality Incentive Demonstration has proven to be successful in the past two years in increasing the quality of hospital health care. Knowledge about the hospital performance is reported on the CMS website which is helpful and necessary to allow consumers to be well informed.

Political and economic background

This program seeks to improve upon the quality of hospital care. According to the Institute of Medicine's 2000 report Crossing the Quality Chasm, 100,000 unnecessary deaths occur in hospitals annually due to low quality care. Federal leadership is needed to sustain the program and its costs for bonuses to Medicare. The bonus money will come from the Medicare Health Insurance Trust Fund. The first year of the program costs ranged from $847,000 to $900. The second year costs for bonuses ranged from $2,829,000 to $744,000.  

Change of government

One of the priorities of the Bush Administration is quality health care. In November 2001, the Department of Health and Human Services announced the Quality Initiative which aims to guarantee quality health care for all Americans.

Purpose and process analysis

Current Process Stages

	Idee	Pilotprojekt	Strategiepapier	Gesetzgebung	Umsetzung	Evaluation	Veränderung/Richtungswechsel
Implemented in this survey?

Origins of health policy idea

The main purpose of Premier Hospital Quality Incentive Demonstration is to improve inpatient quality of care significantly by assessing hospitals and rating them according to quality scores. The highest scoring hospitals receive monetary bonuses. The data is then published on the CMS website to make the general  public aware of the performance of these hospitals.

The Premier Hospital Quality Incentive Demonstrated first started on October 1, 2003, and continued until September 30, 2006.

The performance of each hospital was calculated and then the separate scores for each clinical condition were calculated and resulted in an overall quality score. The hospitals in the top 20 percent are given a bonus.

Premier Hospital Quality Incentive Demonstration is a small scale pilot program that can be implemented on a larger scale if proven successful.

Initiators of idea/main actors

• Regierung: The government provides funds for the implementation of this project through the Medicare Health Insurance Trust Fund. It is projected to be about $8.9 million each year for the three year project.

• Leistungserbringer: The hospitals who participate in this program must be willing to be scored and evaluated. Other hospitals are strongly opposed.

• Patienten, Verbraucher: The goal of this project is to increase the quality of care provided to hospital patients and to allow public access to the information by providing reports on the CMS website.

Approach of idea

The approach of the idea is described as:
new:

Stakeholder positions

Many groups are working together to improve the overall quality of care for patients. This demonstration is currently in progress. The Bush Administration would like to see an overall improvement in quality of care and consumers, along with benefiting from higher quality care, would also like to be informed about various hospital performance. This program seeks to achieve all these objectives.

Actors and positions

Regierung
Medicare program	sehr unterstützend		stark dagegen
Bush Administration	sehr unterstützend		stark dagegen
Democrats	sehr unterstützend		stark dagegen
Leistungserbringer
Hospitals	sehr unterstützend		stark dagegen
Patienten, Verbraucher
Patients	sehr unterstützend		stark dagegen

Influences in policy making and legislation

The Department of Health and Human Services and the Centers for Medicare and Medicaid Services were integral in announcing the Quality Initiative to assure quality health care. The Premier Hospital Quality Incentive Demonstation is a movement to increase quality of hospital care by providing financial incentives to over 250 hospitals. The scores of the evaluated hospitals are reported on the CMS website. CMS is using the Premier project as a pilot test and is currently working on proposals to expand the concept to other health care providers.

Legislative outcome

pending

Actors and influence

Regierung
Medicare program	sehr groß		kein
Bush Administration	sehr groß		kein
Democrats	sehr groß		kein
Leistungserbringer
Hospitals	sehr groß		kein
Patienten, Verbraucher
Patients	sehr groß		kein

Positions and Influences at a glance

Adoption and implementation

The CMS played a large role in providing the funds for the hospital bonuses. This was necessary to provide incentives for the top performing hospitals. The evaluation of the participating hospitals are based on work by such organizations as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the Agency for Healthcare Research and Quality (AHRQ), among others.

Monitoring and evaluation

The hospitals in this program are evaluated yearly based on quality scores for each hospital. Performance scores are based on evidence-based measures for each of the clinical areas. The measures for the individual clinical areas are then aggregated into a single composite score. The average composite score improved significantly between the beginning of the program and the end of the second year. Scores improved dramatically. Improvements ranged anywhere between eight to ten percent for patients with heart failure, pneumonia, hip and knee replacement, Acute Myocardial Infarction (AMI), or coronary artery bypass graft.

Review mechanisms

Halbzeitevaluation

Dimensions of evaluation

Prozess, Ergebnis

Results of evaluation

The average quality scores improved significantly from the initial implementation of the program to the second year. For patients with AMI, scores increased from 87.5 percent to 94.4 percent. Patients with pneumonia, scores increased from 69.3 to 85.8 percent. Patients with hip and knee replacement, scores increased from 84.6 percent to 93.4 percent. Patients with coronary artery bypass graft, scores increased from 84.8 percent to 93.8 percent. Patients with heart failure, scores increased from 64.5 percent to 82.4 percent.

Expected outcome

According to the last evaluation, scores for quality in care has improved in each area on average about ten percent.

Impact of this policy

Qualität	kaum Einfluss		starker Einfluss
Gerechtigkeit	System weniger gerecht		System gerechter
Kosteneffizienz	sehr gering		sehr hoch

Depending upon the success of the Premier Hospital Quality Incentive Demonstration, this project can be implemented on a broader scale and include more hospitals. With the inclusion of more hospitals, overall quality of health care in the United States will improve. Although including more hospitals will result in an increase of spending, in the long term the quality of care in US hospitals will increase.

References

Sources of Information

Weil, Alan. "Patient lives saved as performance continues to improve in groundbreaking CMS/Premier pay-for-performance project." www.premierinc.com. Premier. 7 May 2007. www.premierinc.com/about/news/jan-07/hqid-year2.jsp

Premier Hospital Quality Incentive Demonstration." Centers for Medicare and Medicaid Services. U.S. Department of Health and Human Services. 9 May 2007 www.cms.hhs.gov/HospitalQualityInits/35_HospitalPremier.asp

Kahn, Charles N., Thomas Ault, Howard Isenstein, Lisa Potetz, and Susan Van Gelder. "Snapshot of Hospital Quality Reporting and Pay-for-Performance Under Medicare." Health Affairs 25 (2006): 148-162. 

Author/s and/or contributors to this survey

Das, Kristina and Gerard Anderson

Empfohlene Zitierweise für diesen Online-Artikel:

Das, Kristina and Gerard Anderson. "Premier Hospital Quality Incentive Demonstration". Health Policy Monitor, May 2007. Available at http://www.hpm.org/survey/us/b9/1