CMS, Premier Value-Based Purchasing Demonstration Shows Improvements in Outcomes

Results from CMS and Premier healthcare alliance's Hospital Quality Incentive Demonstration show that participating hospitals have achieved improvements in quality and patient outcomes.

The healthcare reform law requires a Medicare value-based purchasing program to be established for all hospitals beginning in fiscal year 2013, at which time a portion of hospital payments will be linked to its performance on measures related to common and high-cost conditions.

The HQID project, which has been ongoing from Oct. 2003-Sept. 2009, included facilities that volunteered to report their quality data for six high-volume inpatient conditions using national measures of quality care. Hospital participants were given an average composite quality score, which is an aggregate of all process and outcomes measures within each clinical area.

In total, hospital participants received more than $60 million in incentive payments from CMS for performance, improvement and attainment of quality goals. The payment model differed from year to year and can be viewed in detail here.

An analysis of the demonstration's six years revealed the following key findings:

•    Hospital participants raised their overall composite quality score by an average of 18.6 percentage points based on delivery of more than 30 quality measures, such as the proper administration of beta blockers and antibiotics, in six clinical areas.
•    Broken out, hospital participants specifically improved their quality scores for the following six clinical areas:
  • 87.5 percent to 98.1 percent for patients with heart attack
  • 84.8 percent to 97.6 percent for patients with coronary artery bypass graft
  • 64.5 percent to 95.5 percent for patients with heart failure
  • 69.3 percent to 94.8 percent for patients with pneumonia
  • 84.6 percent to 98.0 percent for patients with hip and knee replacement
  • In the Surgical Care Improvement Project clinical area, CQS improved from 85.8 percent to 96.2 percent from Oct. 2006-Sept. 2009 only.
•    Eighteen hospitals moved from the bottom to the top 20 percent of hospitals in one or more clinical areas.

Related Articles on Value-Based Purchasing:

Hawaii and Healthcare Reform: Q&A With Dr. Ginny Pressler of Hawaii Pacific Health
Hospital Outpatient Payments to Increase 1.9% in Final OPPS Rule
5 Keys to Anesthesia's Impact on Value-Based Purchasing

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