CMS-Premier Hospital Quality Incentive Demonstration Project

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CMS-Premier Hospital Quality Incentive
Demonstration Project

• Stephanie Alexander
• Senior Vice President
• Premier Inc.
• Healthcare Informatics
• www.qualitydemo.com

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About Premier

• Premier, Inc., is a strategic alliance owned by
  200 of the United States leading not-for-profit
  hospitals and healthcare systems.
• These systems operate or are affiliated with
  nearly 1,500 hospitals and hundreds of other
  healthcare sites.

Owners Affiliates
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Is there a business case for quality in
hospitals?
Performance Group
Hospitals
Innovation Group
Opportunity Group
Top Performers
Lowest
Performance
Top decile in performance (low cost and high
quality)
Bottom quartile in performance (high cost, low
quality)
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CABG Performance
Source Premier PerspectiveTM
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Non-collaborators financial performance
Source Premier PerspectiveTM
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Collaborators financial performance
Source Premier PerspectiveTM
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CMS/Premier Hospital QualityIncentive
Demonstration Project

• A three-year effort linking payment with quality
  measures
• Top performers identified in five clinical areas
• Acute Myocardial Infarction
• Congestive Heart Failure
• Coronary Artery Bypass Graft
• Hip and Knee Replacement
• Pneumonia
• 278 participating hospitals nationwide

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Identifying Top Performers

• Composite Quality Index will identify hospitals
  performing in the top two deciles in each
  clinical focus group
• Composed of two components
• Composite Process Rate
• Risk-Adjusted Outcomes Index
• Clinical conditions without outcomes indicators
  use only the Composite Process Rate

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Widely accepted quality measures

• The CMS/Premier quality measures are based on
  clinical evidence and industry recognized
  metrics, including
• All 10 indicators from the National Voluntary
  Hospital Public Reporting Initiative
• 27 indicators from the National Quality Forum
  (NQF).
• 24 indicators from CMS 7th Scope of Work.
• 15 indicators from JCAHO Core Measures.
• 3 indicators proposed by The Leapfrog Group.
• 4 indicators from the Agency for Healthcare
  Research and Qualitys (AHRQ) patient safety
  indicators.

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Medicare Payment Incentives

• Incentive payment threshold changes annually for
  each clinical condition
• Top decile performers in a given clinical area
  receive a 2 percent payment supplement per
  condition
• Second decile performers receive a 1 percent
  payment supplement per condition.
• Reduced payments in year 3
• 1 reduction if lt year one ninth decile
• 2 reduction if lt year one tenth decile

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Anticipated payment scenario
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