1. HCQ P MEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAM 1 Overview of Today’s Presentation Strategies available to CMS to improve quality Focus on public reporting and consumer information Current Quality Initiatives, with focus on Hospital work

2. Pursuing Excellence

3. 3 WHAT WE CAN DO TO IMPROVE QUALITY IDENTIFY IMPROVEMENT OPPORTUNITIES AND SELECT APPROPRIATE IMPROVEMENT INTERVENTIONS ADOPT OR DEVELOP MEASURES COLLECT & ANALYZE DATA SELECT PRIORITY AREAS MANAGE PROCESS IN PARTNERSHIP WITH STAKEHOLDERS ESTABLISH & ENFORCE STANDARDS STRUCTURE COVERAGE AND PAYMENTS TO IMPROVE CARE SUPPORT STANDARD METHODS GIVE CONSUMERS INFOR- MATION AND ASSISTANCE TO MAKE CHOICES PROMOTE OR CREATE COLLABORA- TIONS AND PARTNER- SHIPS GIVE PLANS, DOCTORS & PROVIDERS TECHNICAL ASSISTANCE REWARD DESIRED PERFORM- ANCE

4. HCQ P MEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAM 4 CMS Approach to Quality Announced November 2001 by Secretary Thompson: –Empower consumers to make more informed decisions regarding their healthcare –Stimulate / support providers & clinicians to improve the quality of health care

5. HCQ P MEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAM 5 A focus on consumer information, complemented by additional tactics ESTABLISH & ENFORCE STANDARDS REWARD DESIRED PERFORM- ANCE SUPPORT STANDARD METHODS GIVE CONSUMERS INFOR- MATION AND ASSISTANCE TO MAKE CHOICES PROMOTE OR CREATE COLLABORA- TIONS AND PARTNER- SHIPS GIVE PLANS, DOCTORS & PROVIDERS TECHNICAL ASSISTANCE STRUCTURE COVERAGE AND PAYMENTS TO IMPROVE CARE

6. HCQ P MEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAM 6 Comparative Quality Information on www.medicare.gov www.medicare.gov Medicare Health Plan Compare - 1999 Dialysis Facility Compare - 2001 Nursing Home Compare - 2002 Home Health Compare – 2003 Hospital Compare – 2004

7. HCQ P MEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAM 7 The National Voluntary Hospital Reporting Initiative A partnership –American Hospital Association, Federation of American Hospitals, Assoc of American Medical Centers, The Disclosure Group (consumer, union and private purchaser advocates), National Quality Forum, JCAHO, American Medical Association, Nat Assoc of Hosp for Children and Related Inst, Agency for Healthcare Research and Quality, AFL-CIO Public reporting and building of a data infrastructure simultaneously

8. HCQ P MEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAM 8 The National Voluntary Hospital Reporting Initiative –Phase I: report starter set of 10 measures (NOW in progress) –Phase II: report standardized patient perception of care survey (HCAHPS) (late 2004 at earliest) –Phase III: more measures

9. HCQ P MEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAM 9 The Premier Hospital Quality Incentive Demonstration A demo is a way for CMS to send a new message, to test new payment methods This demo: Test how/if financial incentives drive superior quality inpatient care CMS demonstration with Premier, Inc. www.cms.hhs.gov www.cms.hhs.govReports the performance data on www.cms.hhs.gov www.cms.hhs.gov

10. HCQ P MEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAM 10 The Premier Hospital Quality Incentive Demonstration 5 clinical conditions (34 measures) –Acute MI –Heart Failure –Pneumonia –Coronary Artery Bypass Graft –Hip and Knee Replacement

11. HCQ P MEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAM 11 The Premier Hospital Quality Incentive Demonstration Top 50% of hospitals in each clinical area publicly acknowledged on CMS website Bonuses for top 2 deciles for each condition –Top decile given 2% bonus of their Medicare DRG payments for that condition –Second decile given a 1% bonus Possible penalty in third year for laggards

12. HCQ P MEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAM 12 One possible payment scenario 1st Decile Hospital 2 Condition X Top Performance Threshold Payment Adjustment Threshold 2nd Decile 3rd Decile 4th Decile 5th Decile 6th Decile 7th Decile 8th Decile 9th Decile 10th Decile Year One Year TwoYear Three 1st Decile 2nd Decile 3rd Decile 4th Decile 5th Decile 6th Decile 7th Decile 8th Decile 9th Decile 10th Decile 1st Decile 2nd Decile 3rd Decile 4th Decile 5th Decile 6th Decile 7th Decile 8th Decile 9th Decile 10th Decile

13. HCQ P MEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAM 13 The Premier Hospital Quality Incentive Demonstration Voluntary Eligibility: Hospitals in Premier Perspective system as of March 31, 2003 300 hospitals anticipated to participate Demonstration Project: test of concept Could be expanded (with modifications) in the future

14. HCQ P MEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAM 14 Doctor’s Office Quality (DOQ) Project (early stages now) Topics: Preventive care, DM, HTN, CAD, HF, Osteoarthritis, Depression, patient perceptions of care, assessment of systems of care. Clinical measures –Developed in conjunction with AMA/Consortium and with expert panel –Exploring ability to create composite score –Exploring use of claims-based data, EHRs. Process improvements –Care reminders, other

15. HCQ P MEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAM 15 DOQ-IT: Objectives Promote adoption and use of IT in physician offices Create infrastructure for QIO to receive data from electronic office-based systems for use in confidential technical assistance and public reporting Just starting this – completing some early contracting

16. HCQ P MEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAM 16 DOQ-IT: What QIOs will do Assist physicians in decision to adopt –Costs and benefits –Systems availability – registry/EHR –Systems information Provide implementation assistance –Technical issues –Workflow redesign Receive electronic data from physicians and provide improvement assistance –EHR specifications for clinical measures and systems operating reports –Process redesign to support chronic care management

17. HCQ P MEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAM 17 DOQ-IT: Potential Demonstration Requirements for payment –Adopt specified IT systems to improve safety/quality and to manage patients with chronic disease »Full EHR or »E-Rx, e-lab results management, e-registry –Demonstrate use of such systems through electronic data transmitted to QIO –Meet performance targets – public reporting –Meet cost reduction targets (in aggregate) Coordination with Bridges to Excellence program

18. HCQ P MEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAM 18 More Information http://www.cms.hhs.gov/quality/http://www.cms.hhs.gov/quality/http://www.cms.hhs.gov/quality/ Fact sheets on: Hospital Quality Initiative; 3 State Hospital Pilot; H-CAHPS; Nursing Home and Home Health Quality Initiatives, more

19. HCQ P MEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAM 19 Thank you Barbara R. Paul MD 410-786-5629 bpaul@cms.hhs.gov