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Performance-Based Health Care Through Implementing Effective Quality and Cost Measures

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Title: Performance-Based Health Care Through Implementing Effective Quality and Cost Measures


1
Performance-Based Health Care Through
Implementing Effective Quality and Cost Measures

2
Overview
  • Envisioning a future, performance-based health
    care system
  • Progress to date
  • Gaps and barriers
  • Premises, objectives, actions steps, and
    milestones
  • Appendix additional information

3
How did we get here?
  • Charge
  • At its February 29, 2008 meeting, the QASC
    recommended that a road-map be created to clarify
    critical tasks and needed functionalities to
    ensure wide-scale implementation of performance
    measures across the care continuum based on NQF
    endorsed measures.
  • Process
  • Brookings staff was asked to develop discussion
    documents to allow for ongoing input and
    feedback. Staff was aided in this effort by Nancy
    Wilson (AHRQ), Chris Queram (WI Collaborative),
    John Tooker (ACP), and Peter Lee (PBGH).
  • Multiple feedback mechanisms were built into the
    design process between March and June
  • Regular input from QASC chair-persons
  • Two conference calls with the QASC Agenda Group
  • Two conference calls with the full QASC
    membership
  • One call with the QASC Infrastructure Work Group
  • Road-map effort was discussed with HQA and PQA
    members during their June meetings.
  • Several QASC members provided detailed input,
    including Janet Corrigan, Chip Kahn, Debra Ness,
    Gerry Shea, John Tooker, Peter Lee.

As a result of continued feedback road-map has
changed significantly from initial draft to
current document.
4
A future, performance-based health care system
requires
  • payers, providers, and consumers to act
    differently than they do today
  • tools and incentives are available to support
    these actions and
  • wide implementation of valid, patient-level
    performance measures that can confidently be used
    to support the actions of payers, providers, and
    consumers

5
Envisioning the Future
Performance-based Health Care Safe ? Effective ?
Patient-centered ? Efficient ? Timely ? Equitable
  • Provide multiple access modes to culturally and
    linguistically appropriate information
  • Provide incentives and evidence-based coverage
    to consumers for seeking high value care
  • Assess provider performance with
    nationally-endorsed measures
  • Pay differentially based on provider performance
  • Pay providers differentially for performance,
    delivering well-coordinated care and for
    providing support to consumers for
    self-management and shared decision-making
  • Participate actively in their health care
    including shared decision-making and
    self-management
  • Review comparative information on treatments
    and providers
  • Seek high-value care
  • Have available social and environmental support
    that encourages health-promoting behaviors
  • Have available access to seamless,
    well-coordinated primary care, including
    prevention, support for self-management, and
    continuity across settings and providers
  • Have access to real-time data, performance
    feedback and decision-support
  • Systematically analyze and optimize their
    practice patterns in collaboration with other
    providers
  • Effectively coordinate care with other providers
    and institutions in caring for patients
  • Refer patients based on provider performance
  • Are incented to do the right thing
  • Through tools and support encourage patients to
    engage in shared-decision making, effective
    self-management

Payers/ Plans
Consumers
Providers
Foundation Wide Availability of Meaningful
Patient-Level Performance Information
6
Comprehensive Data Needed to Generate
Performance Information
Laboratories
Pharmacies
Care Evaluation
Quality Improvement
Medical Claims
EHRs
Pay for Performance
Consumer Activation
Data Aggregation
Hospitals/ Institutions
Registries
7
Building the capabilities for performance-based
health care relies on
8
Many critical partners engaged today
NQF National Priorities Partners
AHRQ
Foundations Other
List of all involved partners available
NCQA The Joint
Commission AMA PCPI
Medical Societies Medical Specialty
Boards CMS
AHRQ Others
Set national priorities and goals to drive
improvement and affordability
Continuously evaluate health and
health care
QIOs
Regional Collaboratives

Providers
Oversight Organizations
Employers
Health Plans
Improve quality and reduce waste
Consumer Outcomes High Quality Equitable
Affordable Patient-Centered
Develop and test evidence-based measures
Nursing, Academic Communities, etc.
Establish effective public policies, payment
policies, and consumer incentives to reward or
foster better performance
NQF
Fed/State Govt Health Plans Employers
Consumers Providers
Endorse and maintain measures and incorporate
specifications into EHRs
Develop coordinated and streamlined
implementation strategies prioritization,
timelines, and process solutions
Summarize data and generate public reports on
quality and cost
Aggregate data and pilot test and validate
standard performance information
QASC Quality Alliances
Joint Commission NCQA
Medical Specialty Boards
Regional Collaboratives Fed/State Govt.
Health Plans
Others
QASC Regional Collaboratives
RHIOs/HIEs CMS
States Health
Data Stewards
9
Regional-National Feedback is Essential
Innovation
  • National Coordination
  • Performance Measures
  • Methodology
  • Technology
  • Data Aggregation
  • Implementation
  • Promotion of Best Practices
  • Regional
  • Experience
  • Data Aggregation Integration
  • Performance Reporting
  • Consumer Engagement
  • Performance Improvement
  • Regional
  • Experience
  • Data Aggregation Integration
  • Performance Reporting
  • Consumer Engagement
  • Performance Improvement

Consistency
10
The Quality Alliance Steering Committee
  • The Quality Alliance Steering Committee (QASC) is
    a collaborative effort among government agencies,
    physicians, nurses, pharmacists, hospitals,
    health insurers, employers, consumers,
    accrediting agencies, foundations and others
  • QASC co-chairs
  • Carolyn Clancy, MD, Director, Agency for Health
    Care Research and Quality
  • Mark McClellan, MD, PhD, Director, Engelberg
    Center for Health Care Reform at the HVHC Project
    at Brookings Institution.
  • Vision to advance a high-quality, affordable,
    patient-centered health care system through the
    coordination of various groups that are working
    to provide public information on health care
    providers performance.
  • The QASC will actively support the implementation
    and use of effective health care performance
    information for
  • Public reporting and more informed consumer
    decision-making
  • Performance improvement by providers
  • Effective public policies, payment policies, and
    consumer incentives that reward or foster better
    provider performance

11
QASC promotes and facilitates measure
implementation across care continuum
  • The Quality Alliance Steering Committee (QASC)
    facilitates measure implementation by
  • Regularly convening key implementation
    stakeholders
  • Providing guidance on and coordination for
    immediate opportunities for advancing
    implementation goals, including
  • Data Aggregation (across payers)
  • Data Integration (clinical data with
    administrative data)
  • Episode-based cost-of care measure development
  • Promoting measurement and analysis of
    racial/ethnic equity as integral part of
    measurement implementation efforts
  • Stimulating and assessing progress relative to
    implementation goals and milestones
  • Identifying and promoting best practices in
    measure implementation across care sectors
  • Fostering patient-focused measurement and
    reporting (e.g., coordinated episode- and
    patient-level measures across care continuum) in
    implementation efforts
  • Establishing effective interaction/feedback
    mechanisms with regional collaboratives/AFQ/CVEs
    and others

12
We have made progress towardsa performance-based
health care system

13
Progress to date Foundations
By 2003
By 2008
  • TJC Identifying National Patient Safety Goals
    and Core Measure topics
  • NQF Strategic Framework Board Report
  • IOM Priority Areas for National Action
    Transforming Health Care Quality
  • NQF initiates the "priority partners" process.
  • HQA, AQA, PQA focus on prioritization of
    performance measures for implementation

Setting Priorities
  • Research efforts to identify measures
  • TJC, AHRQ, Leapfrog and NCQA develop measures
    for national deployment
  • PCPI formed to develop ambulatory care measures
    for national deployment through physician-led
    effort
  • NQF Safe Practices List
  • TJC, AHRQ, NCQA, Leapfrog PCPI, CMS continue to
    develop measures
  • NQF Safe Practices Update 2006
  • PQA facilitates development of pharmacy measures
  • National Database of Nursing Quality Indicators
    deployed in collaboration with 1,200 hospitals

Measure Development
  • HEDIS, ORYX, OASIS specs available
  • NQF Hospital measures Starter set of 10
    measures (AMI, HF, PNE)
  • NQF Nursing Home Quality Measures
  • Home Health Quality measures
  • Nursing Home Quality Measures selected for
    public report
  • Hundreds of performance measures covering
    multiple care sectors and performance domains
    endorsed by NQF
  • Measure specifications available from multiple
    measure developers.

Endorsement/ Specifications
14
Progress to date Generating Reporting
By 2003
By 2008
  • Various organizations are implementing
    performance measures TJC, NCQA, CMS, Leapfrog, a
    few regional collaboratives.
  • Hospital Quality Alliance (HQA) initiated as
    public-private partnership to prioritize measures
    for implementation and encourage reporting by
    hospitals
  • IHI 100k/5KK Lives Campaign
  • HQA and AQA select measures for implementation
  • QASC formed to address coordination needs for
    measure implementation promoting patient-centric
    measurement and reporting.

Implementation Strategies
  • Pennsylvania Health Care Cost Containment
    Council and New York state CABG medical record
    abstraction plus claims data-1990s
  • AHRQ data aggregation with HCUP
  • Early efforts in CA, MN, WI,
  • Several regional collaborations developed
    systems for data aggregation and integration of
    administrative and clinical data
  • Demonstrations for large-scale aggregation of
    physician performance data are in progress (BQI,
    HVHC)
  • Networks of collaboratives established (AFQ,
    CVE)
  • Demonstrations for nursing, pharmacy and home
    care underway

Data Aggregation
  • TJC expands reports on institutional providers
    via Oryx
  • NCQA provides annual reports on health plans via
    HEDIS
  • A small number of local initiatives provide
    reports on hospitals
  • HQA launches voluntary hospital reporting
    initiative
  • CMS-Compare websites active for hospitals, home
    health LTC
  • AQA principles on public reports established
  • HQA multiple measures reported for Medicare
    beneficiaries
  • Several health plans provide reports on physician
    performance , and links to CMS-compare sites for
    hospitals, home health LTC
  • A few regional collaborations provide local
    reports on providers
  • MA and ME expand reporting requirements to
    nursing measures
  • AHRQ develops TalkingQuality.gov to provide
    guidance on reporting performance information to
    consumers

Performance Reporting
15
Progress to date Use of Information
By 2003
By 2008
  • Bridges to Excellence
  • Various health plan p4p for physicians bonuses,
    withholds, shared savings and tiered networks
  • CMS pilots (1) Premier Hospital Quality
    Demonstration, Medical Group Regional Project
    (2) Medicare Health Support Program with 10
    disease management pilots (3) CMS Hospital
    Market basket incentive- 0.4 reduction in pay if
    hospital does not submit 10 starter set quality
    measures
  • IOM and AHRQ provide reports/recommendations on
    P4P, accountability for quality and cost/shared
    savings models
  • CMS transitioning from "pay-for-reporting" to
    "pay-for-performance. 
  • Virginia Mason pilot with Boeing/ Geisinger
    -warranty for full care
  • MedPAC redesigning physician payment 2008
    bundles

Financial Incentives
  • CMS implements quality initiatives for nursing
    homes, and then hospitals and home health
  • IHI accelerates training of health care
    personnel in PI
  • TJC requires performance improvement for
    hospitals
  • QIOs expand role to facilitate performance
    improvement
  • Numerous organizations provide training to
    health care personnel on performance improvement
  • Several Medical Specialty Boards include
    performance info in MOC
  • Performance improvement programs are commonplace
    in institutional settings, but not physician
    office practice

Performance Improvement
  • Reliance on the "professional model" and
    external entities such as the QIO program.
  • Regional quality coalitions (AFQ) place a
    greater emphasis on QI
  • Some empirical evidence that public reporting
    leads to improved performance

Continuous Evaluation
16
but gaps still exist
  • the nation still lacks a coherent,
    goal-oriented, consistent, and efficient system
    for assessing and reporting on the performance of
    the health care system.
  • - Institute of Medicine, 2006

17
Gaps Barriers I
18
Gaps Barriers II
19
Strategies toAccelerate Progress

20
Strategies Overview
  • Reinforce the Foundations by promoting agreement
    on health care priorities, measure development,
    and efficient endorsement and maintenance
    processes
  • Enable the Generation of Performance Information
    through collaborative and technologically sound
    processes for data integration and aggregation
  • Rapidly expand the Distribution of Performance
    Information
  • Promote effective Use of Performance Information
    for consumers, providers and payers of health
    care

NQF Focus
Focus of QASC, sector-specific alliances this
road-map
Not addressed in detail in this road-map
21
Key premises for strategy development
  • It is urgent to build consensus on a path to
    wide-scale implementation of prioritized and
    endorsed measures across care continuum, all
    payers and an increasingly sophisticated range of
    clinical data sources.
  • This focus will add further momentum to NQFs
    mission of priority setting, promoting needed
    measure development, endorsement, and education.
  • Build on the QASC-endorsed National Framework
    developed by the QASC Vision Workgroup. Flesh
    out specific segments of the framework
    implementation strategies, aggregation of data,
    generation of reports
  • Ensure data aggregation and integration over time
    for the generation of performance information.
  • Ensure harmonization and coordination of measure
    implementation efforts between all care-sector
    specific alliances to ensure, among others, an
    increasing patient-focus (episode-of-care) along
    the care continuum.
  • Focus first on strategic goals/activities and
    needed functionalities to inform work plans for
    QASC and partner organizations.
  • The road-map should tee up critical issues for
    discussion and resolution including
  • Effective interactions between regional and
    national efforts in measure implementation and
    reporting
  • Feedback mechanisms to ensure that measure
    implementation experience informs measure
    maintenance processes of measure developers and
    NQF.

22
Discussion Questions
  • Are the outlined strategic objectives and
    milestones sufficiently bold and clear?
  • Are the outlined next steps appropriate?
  • How do we ensure optimal interaction between
    regional efforts and QASC?
  • How do we ensure optimal interaction between
    rapid implementation of endorsed measures, and
    refinements to NQF prioritization, endorsement,
    and maintenance processes?
  • Is there anything missing from the outlined
    strategies?

23
The Foundations
National Focus
24
Generating Information - I
National Focus
25
Generating Information - II
National Focus
Regional Focus
26
Distributing Performance Information
National Focus
Regional Focus
27
Using Performance Information
National Focus
National Regional Focus
Promoting the effective use of performance
information is currently not a major focus of
QASC and quality alliances. A separate strategy
and road-map could help to reach that goal.
28
Next Steps
  • Refine and finalize the road-map.
  • Update work plans for QASC workgroups based on
    strategic goals/activities of the road-map
  • Identify key activities and next steps for QASC
    including support for all sector-specific
    alliances in implementing work plans and reaching
    goals
  • Communicate the strategic goals and work efforts
    widely to private and public sector
    constituencies and continue to update goals and
    work efforts based on their input.

29
Discussion Questions
  • Are the outlined strategic objectives and
    milestones sufficiently bold and clear?
  • Are the outlined next steps appropriate?
  • How do we ensure optimal interaction between
    regional efforts and QASC?
  • How do we ensure optimal interaction between
    rapid implementation of endorsed measures, and
    refinements to NQF prioritization, endorsement,
    and maintenance processes?
  • Is there anything missing from the outlined
    strategies?

30
AppendicesKey public/private initiatives

31
QASC membership (as of 6/1/08)
  • Mark McClellan (Co-Chair)
  • Carolyn Clancy (Co-Chair)
  • Debra Ness (NPWF)
  • Gerry Shea (AFL-CIO)
  • Jim Guest (Consumers Union)
  • John Rother (AARP)
  • Peter Lee (PBGH)
  • Bruce Bradley (GM)
  • Pam French (Boeing)
  • Clarion Johnson (Exxon Mobil)
  • Brian Marcotte (Honeywell)
  • Andy Webber (NBCH)
  • Karen Ignangi (AHIP)
  • Alan Korn (BCBSA)
  • Nancy Nielsen (AMA)
  • Frank Opelka (ACS)
  • Jeff Rich (STS)
  • John Tooker (ACP)
  • Laura Cranston (PQA)
  • Mary Naylor (Nursing)
  • Bob Dickler (AAMC)
  • Rich Umbdenstock (AHA)
  • Chip Kahn (FAH)
  • Barry Straube (CMS)
  • Peggy OKane (NCQA)
  • Janet Corrigan (NQF)
  • Mark Chassin (TJC)
  • Kevin Weiss (ABMS)
  • John Lumpkin (RWJF)
  • Chris Queram (WI Collaborative)

32
Key Initiatives

33
Ten Simple Rules for the21st Century Health Care
System IOM (2001)
34
NQF National Priority Partners
  • The National Quality Forum (NQF) has committed
    itself to working in partnership with leadership
    organizations to establish national priorities
    and goals for performance measurement and public
    reporting.
  • Topic being addressed by National Priority
    Partners (NPP)
  • Healthcare- Associated Infections (HAIs)
  • Population in health
  • Overuse
  • Avoidable Harms
  • Continuity of Care
  • Patient/ family engagement
  • End of life/ palliative care
  • Reliable and effective care management of
    chronic/ acute episodes
  • www.qualityforum.org/about/NPP

35
AHIC Quality Vision Roadmap
  • Charge of Quality workgroup
  • Make recommendations to the American Health
    Information Community that specify how certified
    health information technology should capture,
    aggregate and report data for a core set of
    ambulatory and inpatient quality measures.
  • Vision
  • In response to the American Health Information
    Community (the Community), the Quality Workgroup
    prepared the following documents to assist the
    Community in its deliberations on recommendations
    it will make to the Secretary to address the
    needs and expectations of health care
    stakeholders. The Workgroup's vision is
    predicated on the idea that performance
    measurement is integral to all aspects of health
    care in the United States and that every citizen
    has the right to expect consistent high-quality,
    safe, and efficient care. The concepts and
    statements in this document are directed to the
    Community and subject to further deliberation by
    the Community.
  • Goals
  • Expanded data element standardization
  • Coding improvements
  • Data exchange and aggregation
  • Quality data set
  • Patient and provider entity record matching
  • Clinical decision support
  • Data stewardship
  • Legal framework for data sharing
  • Patient record de-identification locus
  • Measure set evolution
  • Incentives
  • http//www.dhhs.gov/healthit/ahic

36
Consumer-Purchaser Disclosure Project
  • The Consumer-Purchaser Disclosure Project (CPDP)
    is a collaboration of leading national and local
    employer, consumer, and labor organizations that
    advocate public reporting of provider performance
    information so it can be used for quality
    improvement, consumer choice, and as part of
    payment reform.
  • CPDP in April 2008 announced a comprehensive
    national agreement with leading physician groups
    and health insurers on principles to guide how
    health plans measure doctors performance and
    report the information to consumers. Called the
    Patient Charter for Physician Performance
    Measurement, Reporting and Tiering Programs, it
    creates a national set of principles to guide
    measuring and reporting to consumers about
    doctors performance.
  • www.healthcaredisclosure.org

37
CMSs Better Quality Information Project
  • CMSs Better Quality Information to Improve Care
    for Medicare Beneficiaries (BQI) Project aims to
    pioneer the pooling of private data with Medicare
    claims data to produce more accurate,
    comprehensive quality measures at the provider
    level.
  • Participants in the project include
  • Arizona State Universitys Center for Health
    Information Research (CHIR)
  • California Cooperative Healthcare Reporting
    Initiative
  • Indiana Health Information Exchange
  • Massachusetts Health Quality Partners
  • Minnesota Community Measurement
  • Wisconsin Collaborative for Healthcare Quality
  • www.hhs.gov/valuedriven/pilot/index.html

38
RWJFs Aligning Forces for Quality Initiative
  • Aligns the three key drivers of quality
    improvement at the local level performance
    measurement and public reporting capacity to
    help physicians improve the quality of ambulatory
    chronic illness care and consumer engagement.
  • Participants in the program include
  • Administrator Center for Health Improvement
  • Collaboratives Health Improvement Collaborative
    of Greater Cincinnati, the MetroHealth System
    (Cleveland), Greater Detroit Area Health Council,
    Community Health Alliance of Humboldt-Del Norte,
    Kansas City Quality Improvement Consortium,
    Quality Counts (Maine), Healthy Memphis Common
    Table, MN Community Measurement, The Puget Sound
    Health Alliance (Seattle), Alliance for Health
    (Western Michigan), P2 Collaborative of Western
    New York, Oregon Health Care Quality Corporation,
    Wisconsin Collaborative for Health Care Quality,
    Healthy York County Coalition
  • www.forces4quality.org

39
Key Sector-specific alliances
  • HQA (http//www.hospitalqualityalliance.org)
  • The Hospital Quality Alliance facilitates
    continuous improvement in patient care through
  • Implementing measures that portray the quality,
    cost and value of hospital care
  • Developing and using measure reporting in the
    nation's hospitals and
  • Sharing useful hospital performance information
    with the public.
  • AQA (http//www.aqaalliance.org/)
  • The mission is to improve health care quality
    and patient safety through a collaborative
    process in which key stakeholders agree on a
    strategy for measuring performance at the
    physician or group level collecting and
    aggregating data in the least burdensome way and
    reporting meaningful information to consumers,
    physicians and other stakeholders to inform
    choices and improve outcomes.
  • PQA (http//www.pqaalliance.org/)
  • The Mission of the PQA is to improve health care
    quality and patient safety through a
    collaborative process in which key stakeholders
    agree on a strategy for measuring performance at
    the pharmacy and pharmacist-levels collecting
    data in the least burdensome way and reporting
    meaningful information to consumers, pharmacists,
    employers, health insurance plans, and other
    healthcare decision-makers to help make informed
    choices, improve outcomes and stimulate the
    development of new payment models.

40
HHS-Designated Chartered Value Exchanges
  • Communities designated as Chartered Value
    Exchanges (CVEs) are working with the Centers for
    Medicare Medicaid Services to report
    physician-group level performance information.
    They are also members of a peer-to-peer Learning
    Network sponsored by the Agency for Healthcare
    Research and Quality and have access to HHS
    experts and new tools, including an ongoing
    private Web-based knowledge management system.
  • CVE communities include
  • Wisconsin Healthcare Value Exchange, Madison,
    Wis.
  • Healthy Memphis Common Table, Germantown, Tenn.
  • Greater Detroit Area Health Council, Detroit,
    Mich.
  • Niagara Health Quality Coalition, Williamsville,
    N.Y.
  • Oregon Health Care Quality Corporation,
    Portland, Ore.
  • Pittsburgh Regional Health Initiative,
    Pittsburgh, Pa.
  • Puget Sound Health Alliance, Seattle, Wash.
  • Utah Partnership for Value-driven Health Care,
    Salt Lake City, Utah
  • Louisiana Health Care Quality Forum, Baton
    Rouge, La.
  • Maine Chartered Value Exchange Alliance,
    Scarborough, Maine
  • Minnesota Healthcare Value Exchange, St. Paul,
    Minn.
  • Massachusetts Chartered Value Exchange,
    Watertown, Mass.
  • Alliance for Health, Grand Rapids, Mich.
  • New York Quality Alliance, Albany, N.Y.
  • www.hhs.gov/valuedriven/communities/valueexchanges
    /exchanges.html

41
List of Key Regional Health Initiatives
42
List of Key Regional Health Initiatives
(continued)
43
List of Key Regional Health Initiatives
(continued)
44
Key Regional Health Initiative Locations by State
45
Number of Collaboratives around the country is
growing
Location of a regional collaborative involved
inan initiative (BQI, CVEs, AF4Q, NRHI, CCBH,
NHIN)
46
CMS Quality Initiatives
  • Post Acute Care Reform Plan
  • Home Health Quality Initiatives
  • Hospital Quality Initiatives
  • Nursing Home Quality Initiatives
  • ESRD Quality Initiatives
  • Physician Focused Quality Initiatives
  • Survey and Certification Section
  • Quality Improvement Organizations
  • (in previous slide)

47
Post Acute Care Reform Plan
  • Improved payment plan and coordination of
    post-acute care services for individuals who need
    additional help recuperating from an acute
    illness or serious medical condition
  • Reviewed current industry practices
  • Established overarching principles and vision for
    reform

48
Home Health Quality Initiatives
  • Launched in 2003, the initiative combines new
    quality of care information for consumers with
    the resources necessary to improve the quality of
    home health care.
  • In 2004, the home health quality measures were
    updated on each Medicare-certified home health
    agency to give consumers the ability to compare
    the quality of care provided by the agencies.
  • Home Health Compare
  • Medicare uses the Outcome and Assessment
    Information Set (OASIS) in connection with the
    home care industry to foster and monitor improved
    home health care outcomes.

49
Hospital Quality Initiative
  • Aims to refine and standardize hospital data,
    data transmission and performance measures to
    construct a single robust, prioritized and
    standard quality measure set for hospitals.
  • Consists of
  • National Voluntary Hospital Reporting Initiative
  • Provides useful, valid information about hospital
    quality to the public standardize data and data
    collection and foster hospital quality
    improvement.
  • Three-State pilot of the Hospital Patient
    Perspectives on Care Survey (HCAHPS)
  • As there is no current national standard for
    measuring and collecting data on patients
    satisfaction with care, CMS worked with AHRQ to
    pilot test a survey which would allow consumers
    to compare patient perspectives at different
    hospitals.
  • Premier Hospital Quality Incentive Demonstration
  • Recognizes and provides financial rewards to
    hospitals that demonstrate high quality
    performance in a number of areas of acute care.
  • Hospital Compare
  • Converts data retrieved from hospitals patient
    records to rates that measure how well the
    hospitals care for patients.
  • The Hospital Quality Alliance (HQA) plans to
    increase the number of measures and types of
    conditions/ treatments on which the hospitals
    report.

50
Nursing Home Quality Initiatives
  • Began in 2002 as a six state pilot and was soon
    after expanded to all 50 states
  • Initiative efforts are focused in four areas
  • Regulation and enforcement efforts conducted by
    CMS and State survey agencies
  • Continual, community-based quality improvement
    programs
  • Collaboration and partnership with stakeholders
  • Improved consumer information on the quality of
    care in nursing homes
  • Nursing home compare
  • Collects data in regular intervals on all
    residents in a Medicare or Medicaid certified
    nursing home
  • Information is collected on the residents
    health, physical functioning, mental status and
    general well-being.

51
Physician Focused Quality Initiatives
  • Uses multiple approaches to promote the adoption
    of quality strategies
  • Doctors Office Quality (DOQ) Project
  • Designed to develop and test a comprehensive,
    integrated approach to measuring and improving
    the quality of care for chronic diseases and
    preventive services in outpatient settings.
  • Doctors Office Quality-Information Technology
    (DOQ-IT) Project
  • Aims to support the adoption and effective use of
    information technology by physicians offices.
  • Payment Demonstration Projects
  • Examines financial incentives for physicians that
    demonstrate higher quality performance
  • End Stage Renal Disease (ESRD) Quality
    Initiatives

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ESRD Quality Initiatives
  • Required by the Balanced Budget Act of 1997, CMS
    developed and implemented a method to measure and
    report the quality of renal dialysis services
    provided by Medicare programs.
  • CMS supported the development of 16 clinical
    performance measures (CPMs)
  • Dialysis Facility Compare
  • Allows patients, families and professionals to
    compare the quality of dialysis facilities
    nationally and access a range of kidney and
    dialysis resources
  • Information is retrieved from SIMS and REMIS

53
Breakthrough Initiatives
  • Series of projects focused on specific areas
    where large quality gaps exist and next steps
    have been identified
  • National Influenza and Pneumococcal Vaccination
    Campaign
  • Nursing Home Immunizations
  • Dialysis Immunizations
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