Incentive for Quality
As federal and state governments are
providing consumers
with statistics on hospital quality, Medicare has begun a
demonstration project to pay more for higher performance.
with statistics on hospital quality, Medicare has begun a
demonstration project to pay more for higher performance.
In April of this year, the Centers for
Medicare and Medicaid Services (CMS) began offering an on-line
service to help Americans compare the quality of care in
hospitals. The on-line service presents data from 3,900
acute-care hospitals (general hospitals) and critical access
hospitals (small hospitals in remote areas). This represents 98
percent of hospitals in those categories. Specialty hospitals,
including those for children, psychiatric patients, and
rehabilitative services, are not part of the program.
The service, called
“Hospital Compare,” can be accessed on line at: www.hospitalcompare.hhs.gov Once at the site, the user can search for
hospitals by state, county, city, zip code, or hospital name.
When searching for multiple hospitals, the hospitals’
ratings appear as side-by-side bar graphs along with bar graphs
showing averages for hospitals in the state and across the
country. Persons without Internet access can obtain the same
information by calling 1-800-MEDICARE (1-800-633-4227).
Focus on three conditions
Hospital Compare currently tracks quality
measures for three common and serious conditions: heart
attack, heart failure, and pneumonia. The measures are simple,
well-accepted interventions for which it can be determined
whether the hospital performed the service or did not.
For example, for
patients with heart attack, the data collected includes whether
the hospital provided an aspirin at arrival and a thrombolytic
agent (clot buster) within 30 minutes of arrival. For patients
with pneumonia, the measures include whether blood culture was
performed before initial antibiotic was received and whether an
antibiotic was administered within four hours of arrival at the
hospital. (For a list of the seventeen quality measures, see
sidebar below.) If the service was not appropriate for a
particular patient—such as if the patient was allergic to
the recommended medication—the decision not to provide
the service would not adversely affect the hospital’s
rating.
The Hospital Compare
Web site advises patients: “[I]t is important to
know that small differences in the percentages usually
don’t show that one hospital is significantly better or
worse. It is better to look at larger differences.”
Incentive to report
The program to gather data is part of the Medicare Prescription Drug, Improvement and
Modernization Act of 2003. In
addition to providing a drug program for seniors, the act
created a strong incentive for hospitals to report the data. If
hospitals report the data, they will receive the full level of
Medicare reimbursement, including what the act calls the annual
“market basket percentage increase for hospitals in all
areas.” In the most recent year, the hospital’s
market basket increase was 3.2 percent.
If the hospital does
not report the data, its market basket increase is reduced by
0.4 percent. Thus, in the most recent year, a hospital that did
not submit data would receive a 2.8 percent increase instead of
a 3.2 percent increase. For the average hospital, that would be
a reduction in Medicare reimbursements of about $400,000 per
year.
As a result of the
incentive program and the high proportion of hospitals
reporting data, physicians can expect hospitals to require them
to follow the recommendations of the federal quality measures
or document in the patients’ charts why the particular
type of care has not been provided.
The federal government
plans to expand the list of quality measures. Future measures
are likely to include infection rates and the satisfaction of
patients with the nature of the care. Currently, the Hospital
Compare Web site receives about 150,000 hits per day. As the
program becomes more well known and as quality measures expand,
utilization of the Web site probably will increase. (For a
description of the top five reasons Medicare beneficiaries are
hospitalized, see sidebar on next page.)
