CHARLOTTE, NC – As Congress wrestles with how to improve care and lower costs, fourth-year results from the nation's largest hospital pay-for-performance program has federal leaders hopeful that P4P may be an answer.
The results showed patients live longer and receive recommended treatments more frequently.
Hospitals participating in the Centers for Medicare and Medicaid Services/Premier healthcare alliance Hospital Quality Incentive Demonstration (HQID) value-based purchasing project raised their overall quality by an average of 17.2 percent over four years based on their delivery of more than 30 nationally standardized and widely accepted care measures to patients in five clinical areas.
The improvements saved the lives of an estimated 4,700 heart attack patients in four years, according to a Premier analysis.
The more than 1.5 million patients treated in five clinical areas at the 230 participating hospitals also received approximately 500,000 additional recommended evidence-based clinical quality measures, such as smoking cessation, discharge instructions and pneumococcal vaccination.
Additional research by Premier, using the Hospital Compare dataset, showed that by March 2008, HQID participants scored on average 6.9 percentage points higher than non-participants on 19 performance measures used by the government's scorecard for hospital quality.
The HQID project has served as a basis for CMS' proposal to Congress for a national VBP or pay-for-performance program.
"The HQID project is the only large-scale hospital value-based purchasing project showing that financial incentives can increase quality of care," said Charlene Frizzera, acting administrator of CMS. "CMS and Premier have built a substantial body of evidence showing that these types of payment reforms have a direct effect on improving quality and enhancing value."
According to Susan DeVore, Premier's president and CEO, the status quo system of reimbursing hospitals is broken. "Trying to move the payment system to pay for quality and not solely for volume makes sense, especially when we have substantial evidence to prove that this payment model creates the right incentives to drive continuous improvement," she said. "The new payment model is based on lessons learned during the first three years of the project and reflects what we expect to see in a national VBP plan."
"This is the right reform, at the right time, to improve care in the long run," DeVore added.
According to the latest results, the new payment model has shown to promote increased quality improvements in the project. Thirteen hospitals moved from the bottom to the top 20 percent of hospitals in one or more clinical areas, improving quality scores by an average of 28.1 percentage points over four years.
Under the project extension's new reimbursement model, CMS announced that it will award incentive payments of almost $12 million to 225 providers for top performance, as well as top improvement and for reaching a level of attainment, in the project's five clinical areas.
Overall, 1,258 awards were given to these top providers in the fourth year of the project, a five-fold increase from previous years. Through the project's first four years, CMS has awarded more than $36.5 million to top providers.
