Participants in CMS, Premier healthcare alliance HQID VBP project raise quality by 18.3%

With value-based purchasing (VBP) now law under health reform, hospitals participating in the nation's largest hospital VBP demonstration are providing lessons learned that can help others save lives and better craft rules to govern the new program.

“Through the power of collaboration, the alliance is transforming healthcare to benefit the health of communities nationwide. HQID is one illustration of this commitment and an example of what can be accomplished.”

Participants in the Centers for Medicare & Medicaid Services (CMS), Premier healthcare alliance Hospital Quality Incentive Demonstration™ (HQID) VBP project raised their overall quality by an average of 18.3 percent over five years. This is based on their delivery of more than 30 nationally standardized and widely accepted quality measures to patients in six clinical areas.

Performance improvements saved the lives of an estimated 6,500 heart attack patients in five years, according to a Premier analysis of mortality rates at hospitals participating in the project. The more than 2 million patients treated in the six clinical areas at the 225 participating hospitals also received approximately 700,000 additional evidence-based clinical measures, such as the proper administration of aspirin, beta blockers and antibiotics.

CMS announced that it will award incentive payments of almost $12 million in year five to 218 providers for top performance and top improvement, as well as awards for attaining quality goals in the project's six clinical areas. Click here for a list of year five top-performing hospitals. Overall, CMS has awarded more than $48 million over five years to top providers.

HQID served as a basis for CMS' proposal to Congress for a national VBP or pay-for-performance (P4P) program. With five years experience as part of the program, participants are helping to inform the implementing regulations for VBP, which are expected later this year. The project was also cited as a test bed for reform by the Senate Finance Committee as part of healthcare reform.

According to Susan DeVore, president and CEO of the Premier healthcare alliance, "HQID is the first large-scale hospital collaborative to test the impact of economic incentives on quality. As we move our reimbursement system from pay-for-quantity to pay-for-quality, HQID participants will have extensive experience with this value-based purchasing model, having set a quality improvement standard for the whole nation."

Additional research by Premier using the Hospital Compare dataset showed that by September 2008, HQID participants scored on average 6.4 percentage points higher (95.05 percent to 88.64 percent) than non-participants when evaluating 19 common Hospital Compare measures.

A recent peer-reviewed study in the Annals of Internal Medicine showed that HQID hospitals caring for a higher proportion of poor patients improved at a more rapid rate than those not participating in the project.

Continued DeVore, "Through the power of collaboration, the alliance is transforming healthcare to benefit the health of communities nationwide. HQID is one illustration of this commitment and an example of what can be accomplished."

The HQID project

Hospitals participating in HQID include small/large, urban/rural and teaching/non-teaching facilities that volunteered to report their quality data for six high-volume inpatient conditions using national measures of quality care.

Through the project, Premier collects a set of more than 30 evidence-based clinical quality measures from participating hospitals.

The quality measures were developed by government and private organizations such as CMS, The Joint Commission, the Agency for Healthcare Research and Quality, and the Leapfrog Group. In addition, measures have been endorsed by the National Quality Forum, and the American Hospital Association-led Hospital Quality Alliance. For more information on the measures, go to www.qualitydemo.com.

Quality improvements

The average composite quality score (CQS), an aggregate of all process and outcomes measures within each clinical area, improved by 18.3 percent over the project's first five years (October 2003 to September 2008).

• From 87.5 percent to 97.9 percent for patients with AMI (heart attack);
• From 84.8 percent to 97.7 percent for patients with coronary artery bypass graft (CABG);
• From 64.5 percent to 93.8 percent for patients with heart failure (HF);
• From 69.3 percent to 95.4 percent for patients with pneumonia (PN);
• From 84.6 percent to 97.3 percent for patients with hip and knee (HK) replacement;
• From 85.8 percent to 93.1 percent for Surgical Care Improvement Project (SCIP) patients (year four-year five only).

Award criteria

CMS extended the project for three additional years through September 2009 to test the effectiveness of new incentive models and ways to improve patient care. Beginning with year four results, participants are eligible to receive the following awards:

1. Top Performance Award -The top 20 percent of hospitals in each clinical area will receive an additional incentive payment. This group will receive the Attainment Award as well.

2. Improvement Award - Hospitals that attain median level performance and are among the top 20 percent of hospitals with the largest percentage quality improvements in each clinical area will receive an additional incentive payment.

3. Attainment Award - Hospitals that attain or exceed the median level composite quality score (CQS) benchmark from two years prior will receive an incentive payment.

All year five awards were based on the change in the hospital CQS in the performance year compared to two years prior (year three to year five). Participants are eligible to receive a maximum of 12 awards.

The new payment model has led to increased quality improvements in the project. Twelve hospitals moved from the bottom to the top 20 percent of hospitals in one or more clinical areas, improving quality scores by an average 26.5 percentage points over five years.

HQID is informing the structure of VBP by providing:

• A real world test bed to assess the potential performance improvement on quality and outcomes measures on a year over year basis;
• Insights on the need to fully test new quality and outcomes measures to ensure that they can be accurately captured;
• Understanding on the need for and how to assess and set benchmarks for both attainment and improvement to the measures;
• Understanding on hospital performance given the wide variation in the populations served by different hospitals (rural/urban; disproportionate share hospital (DSH)/non-DSH); and
• Identification of topped-out measures.

HQID year five top performers

Received all awards for which they were eligible

12 awards

• Memorial Regional Medical Center, Mechanicsville, Va. (Bon Secours Richmond Health System)

10 awards (not eligible for CABG awards)

• Alegent Health Midlands Hospital, Papillion, Neb.
• Catawba Valley Medical Center, Hickory, N.C.
• Conway Medical Center, Conway, S.C.
• DePaul Medical Center, Norfolk, Va. (Bon Secours Hampton Roads Health System)
• Fremont Area Medical Center, Fremont, Neb.
• Saint Louise Regional Hospital, Gilroy, Calif. (Daughters of Charity Health System)

Eight awards (not eligible for CABG, AMI awards)

• St. Anthony Community Hospital, Warwick, N.Y. (Bon Secours Charity Health System)

Six awards (not eligible for CABG, AMI, HK awards)

• Mariners Hospital, Tavernier, Fla. (Baptist Health South Florida)

Four awards (only eligible for HF, PN awards)

• Northside Hospital, Johnson City, Tenn. (Mountain States Health Alliance)

Received all awards but one for which they were eligible

11 awards (of 12 possible)

• Heartland Regional Medical Center, St. Joseph, Missouri (Heartland Health)
• Presbyterian Hospital, Plano, Texas (Texas Health Resources)
• Western Baptist Hospital, Paducah, Ky. (Baptist Healthcare System)

Nine awards (of possible 10; not eligible for CABG awards)

• Aurora Memorial Hospital of Burlington, Wis. (Aurora Health Care)
• Berkshire Medical Center, Pittsfield, Mass. (Berkshire Health Systems)
• Harris Methodist Walls Regional Hospital, Cleburne, Texas (Texas Health Resources)
• Memorial Hospital Pembroke, Pembroke Pines, Fla. (Memorial Healthcare System)
• Southside Hospital, Bay Shore, N.Y. (North Shore-Long Island Jewish Health System)
• Sycamore Medical Center, Miamisburg, Ohio (Kettering Health Network)
• United Hospital Center, Bridgeport, W.Va.

Received 10 total awards (of 12 possible)

• Alegent Health Immanuel Medical Center, Omaha, Neb.
• Aurora BayCare Medical Center, Green Bay, Wis. (Aurora Health Care)
• Baptist Hospital of Miami, Miami (Baptist Health South Florida)
• Bryn Mawr Hospital, Bryn Mawr, Pa. (Main Line Health)
• CaroMont Health Gaston Memorial Hospital, Gastonia, N.C.
• Kettering Medical Center, Kettering, Ohio (Kettering Health Network)
• Rush Foundation Hospital, Meridian, Miss. (Rush Health Systems)
• St. Anthony Hospital, Oklahoma City, Okla. (SSM Health Care)
• St. Joseph Hospital - Orange, Orange, Calif. (St. Joseph Health System)
• St. Mary Medical Center, Apple Valley, Calif. (St. Joseph Health System)
• St. Vincent Healthcare, Billings, Mont. (Sisters of Charity of Leavenworth Health System)
• St. Vincent Medical Center, Los Angeles (Daughters of Charity Health System)
• Staten Island University Hospital, Staten Island, N.Y. (North Shore-Long Island Jewish Health System)
• Thomas Jefferson University Hospital, Philadelphia (Thomas Jefferson University Hospitals/ Jefferson Health System)
• West Virginia University Hospitals, Morgantown, W.Va.