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Medicare News
Study of Medicare Patients Finds Many Lives Saved by
Hospital Quality Measures
Hospitals also reduce costs says Premier report
September 2 2006 - Wider adoption of quality
measures used in a groundbreaking Medicare pay-for-performance
demonstration project could save thousands of lives and reduce hospitals
costs, according to an analysis released yesterday by the Premier Inc.
healthcare alliance.
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According to Premier’s analysis, if all pneumonia,
heart bypass, heart attack (acute myocardial infarction), and hip and
knee replacement patients nationally received most or all (76 to 100
percent) of a set of widely accepted care processes in 2004, it could
have resulted in nearly 5,700 fewer deaths; 8,100 fewer complications;
10,000 fewer readmissions; and 750,000 fewer days in the hospital. In
addition, hospital costs could have been as much as $1.35 billion lower.
“This analysis is extremely valuable because it
provides empirical evidence supporting the concept of the business case
for quality,” said Dr. Peter K. Lindenauer M.D. M.Sc., Medical Director,
Clinical and Quality Informatics for Baystate Health in Springfield,
Mass. “Not only is it possible for hospitals to provide high quality
care efficiently, but in fact those institutions that achieve
outstanding quality performance appear to benefit from reduced costs and
improved outcomes.”
The analysis is based on data from Premier’s
Hospital Quality Incentive Demonstration (HQID) pay-for-performance
demonstration project with the Centers for Medicare and Medicaid
Services (CMS). Through that project, Premier collects a set of 33
quality indicators from more than 250 hospitals across the country.
Using clinical quality measure data that has been audited and validated
by CMS, Premier undertook additional analysis using the detailed cost
and clinical data available in Premier's Perspective™ database, the most
comprehensive clinical, financial and operational comparative database
in the nation.
"Our nation's current healthcare payment system
pays all hospitals the same way regardless of the quality of care
delivered," said U.S. Representative Sue Myrick. "These new findings
point the way toward a payment system that rewards hospitals for
delivering higher quality care. A common sense, outcomes-based system
will hopefully be a better one for both patients and hospitals."
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Care steps tracked |
|
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Participants in
the project achieved statistically significant improvements in
quality of care, as measured by thirty-three process and outcome
measures, in the five clinical areas of:
Acute
Myocardial Infarction (AMI)
1. Aspirin at
arrival
2. Aspirin
prescribed at discharge
3. Angiotension
converting enzyme inhibitor (ACEI) for left ventricular systolic
dysfunction
(LVSD)
4. Adult smoking
cessation advice/counseling
5. Beta blocker
prescribed at discharge
6. Beta blocker
at arrival
7. Thrombolytic
agent received within 30 minutes of hospital arrival
8. Percutaneous
coronary intervention (PCI) received within 120 minutes of
hospital arrival
9. Inpatient
mortality rate
Coronary
Artery Bypass Graft (CABG)
1. Aspirin
prescribed at discharge
2. CABG using
internal mammary artery (IMA)
3. Prophylactic
antibiotic received within one hour prior to surgical incision
4. Prophylactic
antibiotic selection for surgical patients
5. Prophylactic
antibiotics discontinued within 24 hours after surgery end time
6. Inpatient
mortality rate
7. Post operative
hemorrhage or hematoma
8. Post operative
physiologic and metabolic derangement
Pneumonia (PN)
1. Oxygenation
assessment
2. Pneumococcal
vaccination
3. Blood culture
before first antibiotic
4. Adult smoking
cessation counseling
5. Initial
antibiotic selection
6. Initial
antibiotic within four hours of hospital arrival
7. Flu
vaccination
Hip and Knee
Replacement Procedures (Hip/Knee)
1. Prophylactic
antibiotic received within one hour prior to surgical incision
2. Prophylactic
antibiotic selection for surgical patients
3. Prophylactic
antibiotics discontinued within 24 hours after surgery end time
4. Postoperative
hemorrhage or hematoma
5. Postoperative
physiologic and metabolic derangement
6. Readmissions
30 days post discharge
Heart Failure
(HF)
1. Left
ventricular function (LVF) assessment
2. Discharge
instructions
3. Angiotension
converting enzyme inhibitor (ACEI) for left ventricular systolic
dysfunction (LVSD) 4. Adult smoking cessation advice/counseling |
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Congress has mandated that Medicare develop a plan
to implement “value-based purchasing,” which ties payment to quality of
care and other outcomes, beginning with FY2009. The CMS/Premier Hospital
Quality Incentive Demonstration Project (HQID) is a test of one
value-based purchasing model.
The analysis grouped patients by the number of care
processes they received and then examined costs and outcomes across each
group. Because the data on care processes are not available from all
hospitals, Premier researchers extrapolated the national implications
based on discharge data from the Agency for Healthcare Research and
Quality (AHRQ) Healthcare Cost and Utilization Project (HCUP).
“Our goal with this project is to improve patient
outcomes by encouraging the reliable delivery of basic care processes
which result in lower mortality, fewer readmissions, fewer complications
and shorter lengths of stay,” said Richard A. Norling, president and CEO
of Premier. “Through our work with hundreds of hospitals across the
nation, we have found that they are able to implement these care
processes without a great deal of expense, new technology or staff time.
This truly is win-win healthcare.”
The 33 evidence-based clinical quality measures
were developed by government and private organizations (for more
information on the indicators, go to:
www.qualitydemo.com). See details in sidebar at right.
“As the first real-world test of these quality
measures, this project represents an important step forward in our
understanding of the impact of process improvement on patient outcomes,”
said Maureen Bisognano, executive vice president and chief operating
officer of the Institute for Healthcare Improvement (IHI). “This study
clearly identifies the positive results for patients when providers
reliably implement a set of evidence-based care practices.”
While the study findings from patients receiving
care for pneumonia, heart bypass, heart attack and hip and knee
replacement procedures are extremely positive, the findings from heart
failure patients demonstrate a need for continued evaluation into the
relationship between improved process delivery and outcomes. Heart
failure patients who received all the care processes had longer hospital
stays and more complications but fewer readmissions. Premier also found
that during the study time period, heart failure patients were more
likely to have extensive diagnostic procedures and surgical
interventions, both of which would increase costs of care and increase
risk for the complications studied but may reflect the most appropriate
care for the patient.
"It is important for hospital leadership to
understand the study findings because the care processes tracked by the
project are largely managed and delivered by hospital staff," said
Douglas Hawthorne, chairman of the Premier board of directors and
president and CEO of Texas Health Resources, which has 13 hospitals
participating in the demonstration project.
"Premier's study identifies actions hospital staff
can take today to improve outcomes," Hawthorne said. "The study
indicates that patients could benefit tremendously when hospitals
deliver all of these care processes every time."
About Premier Inc.
A healthcare alliance entirely owned by more than 200 of the nation’s
leading not-for-profit hospitals and healthcare systems, Premier Inc.
helps hospitals accelerate both clinical and financial performance.
Premier’s shareholders operate or are affiliated with 1,500 hospitals
and more than 41,000 other healthcare sites. Premier’s members and
clients benefit from group purchasing and supply chain services,
clinical and operational performance measurement, benchmarking and
insurance programs. Headquartered in San Diego, Calif., Premier has
offices in Charlotte, N.C., and Washington, D.C. For more information,
visit
www.premierinc.com.
What is the
relationship between Premier and CMS?
In 2003, CMS approved a
three-year demonstration project – the Hospital Quality Incentive
Demonstration (HQID) pay-for-performance project – in which Premier
collects 33 clinical quality indicators – or care steps - from more than
250 hospitals. The project measures how well hospitals deliver each of
the care steps. The hospitals with the highest scores receive additional
payment from Medicare at the end of each year of the project. Detailed
information about this project is available online at
www.qualitydemo.com.
The CMS Web site has information as well at
http://www.cms.hhs.gov/HospitalQualityInits/35_HospitalPremier.asp.
Medicare paid $8.85 million in first-year incentives to the
top-performing hospitals in the project.
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