Skip Navigation Archive: U.S. Department of Health and Human Services www.hhs.gov
Archive: Agency for Healthcare Research Quality www.ahrq.gov
Archive print banner

This information is for reference purposes only. It was current when produced and may now be outdated. Archive material is no longer maintained, and some links may not work. Persons with disabilities having difficulty accessing this information should contact us at: https://info.ahrq.gov. Let us know the nature of the problem, the Web address of what you want, and your contact information.

Please go to www.ahrq.gov for current information.

Buy-Right for Health Care Quality: Evidence and Indicators: Paying for Performance

Slide Presentation by Stephanie Alexander


On October 21, 2004, Ms. Alexander made a presentation in a Web conference entitled Buy-Right for Health Care Quality: Evidence and Indicators: Paying for Performance.

This is the text version of Ms. Alexander's slide presentation. Select to access the PowerPoint® Slides (448 KB).


CMS-Premier Hospital Quality Incentive Demonstration Project

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

Slide 1

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.

This slide contains a map of the 50 states containing the locations of Owners and Affiliates belonging to the Premier strategic alliance.

Slide 2

Is there a business care for quality in Hospitals?

This slide contains a chart using a curve representing all hospitals. The horizontal axis is labeled "Performance" starting from "Top Performers (Labeled below this is "Top decile in performance" and in parenthesis "low cost and high quality")" to "Lowest (Labeled below this is "Bottom Quartile in performance" and in parenthesis "high cost, low quality")." The curve is divided into three sections. The first and best performing group is labeled "Innovation Group", the second "Performance Group," and the group with the poorest quality is the "Opportunity group."

The part of the curve representing the Innovation group is a very small darkened sliver of the total curve. The performance group section of the curve juts sharply up and includes the peak of the curve and includes a slight decline at the end. The Innovation group and the Performance group together are slightly less than half of the Opportunity group section of the curve. The Opportunity group section of the curve includes a decline more gradual than the incline included in the first and second groups. This section is darkened. Each group is separated by a visible line on the chart.

Slide 3

CABG Performance

This slide contains a table displaying the statistics from the three groups described in the previous slide. The Innovation group has 7 Hospitals (source: Premier-Perspective); 4,024 Isolated CABG Procedures: Discharges; a Wage and Severity - Adjusted Average Cost of $16,043; a Risk-Adjusted Inpatient Mortality of 2.78%; a .62% rate of return to the operating room; and 91.39% Aspirin use during hospitalization.

The Performance Group has 46 hospitals, 11,853 Isolated CABG Procedures: Discharges; a Wage and Severity - Adjusted Average Cost of $20,123; a Risk-Adjusted Inpatient Mortality of 2.92%; a 2.12% rate of return to the operating room; and 67.65% Aspirin use during hospitalization.

The opportunity Group has 17 hospitals, 5,397 Isolated CABG Procedures: Discharges; a Wage and Severity - Adjusted Average Cost of $26,321; a Risk-Adjusted Inpatient Mortality of 3.29%; a 2.43% rate of return to the operating room; and 54.57% Aspirin use during hospitalization.

Cost, Mortality, and operating room returns decrease with increased performance.

Slide 4

Non-collaborators' financial performance

This slide contains a graph labeled "Average Wage-adjusted Cost pre Case for CABG: Non-Collaborators" with horizontal axis labeled "Month" and is scaled by month from Jan. 98' to Sep. 00'; and vertical axis labeled "Wage-Adjusted Cost" and is scaled from 15000 to 24000. A line plot is shown gradually increasing from 98' to 00'. The Source is "Premier Perspective. This plot starts at $21,000 in January 1998 and gradually increases to $24,000 by September 2000. A line at $22,000 with a margin represented by two dotted lines at $21,000 and $23,000 are included for the viewer's references and show that costs are instable.

Slide 5

Collaborators' financial performance

This slide contains a graph labeled "Average Wage-adjusted Cost pre Case for CABG: Collaborators" with horizontal axis labeled "Month" and is scaled from Jan. 98' to Sep. 00'; and vertical axis labeled "Wage-Adjusted Cost" and is scaled from 15000 to 24000. A line plot is shown holding steady from 98' to 00'. The Source is "Premier Perspective.

This plot starts at $19,500 in January 1998 and stays within a margin of $21,000 and $18,000 (represented by dotted lines - there is a midpoint line at $19,700) to end at $19,700 by the end of September 2000. In comparison to the previous graph on non-collaborators, this plot shows that costs were controlled and kept low while costs on the non-collaborators increased and continue to rise.

Slide 6

CMS/Premier Hospital Quality Incentive 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.

This slide contains a map of the United States with the location of the participating hospitals plotted.

Slide 7

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.

Slide 8

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 Quality's (AHRQ) patient safety indicators.

Slide 9

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 < year one ninth decile.
    • 2% reduction if < year one tenth decile.

Slide 10

Anticipated payment scenario

This slide contains a chart showing the Top Performance Threshold in relation to the Payment Adjustment threshold of a model hospital for a "condition X" over a three year period. Each year is represented by a column of ten boxes which are labeled from 1st decide to 10th decile. There is a bold line separating the 2nd and 3rd Decile of each group of hospitals and is labeled as the "Top Performance Threshold." This is one bold line crossing the 8th and 9th Decile of the first year column. The Performance increases over the three years in relation to the Payment Adjustment Threshold.

Slide 11

Heart Failure: Pre-release vs. 4 Q03 Median Comparisons Premier HQI Demonstration Project Participants Preliminary Data

This slide contains a bar chart. The horizontal axis labeled "measure" where the measures are the following:

  • Discharge instructions.
  • LVF assessment.
  • ACEI for LVSD.
  • Adult smoking cessation counseling.
  • Composite Quality Score.

Each measure contains two bars; one representing "pre-release" rates (group 1) and the other representing "4 quarters in 2003" rates (group 2).

The vertical axis is labeled "rate" and is scaled from 0%-100%. The measures are the following:

  • Discharge instructions (32.19% [group 1], 38.10% [group 2]).
  • LVF assessment (83.08%, 85.81%).
  • ACEI for LVSD (75.00%, 77.97%).
  • Adult smoking cessation counseling (51.61%, 65.79%).
  • Composite Quality Score (60.47%, 64.27%).

Slide 12

Composite Score: All 34 HQI Project Measures HQI Project Time Period: 4Q03 vs. 4Q03 - 1Q04

This slide contains a bar chart. The horizontal axis labeled "Decile Threshold" where the measures are the following:

  • Top.
  • 2nd.
  • Median.
  • 8th.
  • Bottom.

Each measure contains two bars; one representing "pre-release" rates (group 1) and the other representing "4 quarters in 2003" rates (group 2).

The vertical axis is labeled "Composite score" and is scaled from 0%-100%. The measures are the following:

  • Top (86.5%,87.2%).
  • 2nd (69.7%, 71.3%).
  • Median (76.9%, 78.3%).
  • 8th (83.0%, 84.1%).
  • Bottom (65.4%, 66.6%).

Current as of March 2005


Internet Citation:

CMS-Premier Hospital Quality Incentive Demonstration Project. Text version of a slide presentation at a Web conference. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/ulp/buyright/alexandertxt.htm


Return to Web Conference

The information on this page is archived and provided for reference purposes only.

AHRQ Advancing Excellence in Health Care