Medical Device Daily
Aetna (Hartford, Connecticut) reported yesterday that it has entered into a pay-for-performance (P4P) contract with the NYU Medical Center (New York).
Under the new “hospital services compensation schedule,” Aetna will financially reward NYU Medical Center for superior performance and/or continuous improvement on nationally recognized measures of patient safety and quality of care, as well as mutually agreed upon measures for efficient delivery of medical services. If successful, this P4P pilot is intended to serve as a model for future Aetna hospital contracts in the New York market, the company said.
Financial terms were not disclosed.
The performance measures being used for NYU Medical Center are based on the recommended guidelines of nationally respected medical professional organizations, and include payment incentives NYU had a hand in designing, Aetna said.
“From NYU’s perspective, we do believe that these kind of activities will be in our best interest down the road, we believe we provide high quality care, and we are looking for ways to measure and monitor that,” Rick Donoghue, senior VP for strategy at NYU Medical Center, told Medical Device Daily .
Donoghue said the timing of this pilot program is significant for NYU because Medicare has a congressional mandate to adopt P4P in 2008, representing about 40% of the Medical Center’s patient population. “This feels like a better way to introduce the community to this type of an arrangement,” Donoghue said.
The program aims to achieve member care that is effective and efficient, member care that meets clinical quality standards and results in quality of care and outcome improvements for members, care practices that promote patient safety, and administrative efficiencies that improve the timeliness and transactional costs of administration between Aetna and NYU Medical Center.
For the Aetna/NYU Medical Center pilot, 50% of the criteria are derived from nationally established quality benchmarks employers use to evaluate health plan performance, and which have been adopted by the Centers for Medicare and Medicaid Services (CMS); 30% involve clinical performance measures, such as length of stay and hospital readmission rates; and the final 20% are based on patient-safety yardsticks developed by the Leapfrog Group2, the business consortium representing 34 million employees from Fortune 500 and other companies.
The Leapfrog Group named NYU Medical Center among the top 50 hospitals in the nation in its first Hospital Quality and Safety Survey late last year.
“We spent a considerable amount of time — several months — working with Aetna in a very collaborative way, trying to identify those measurements that were out in the public domain that others are already focusing in on, but that have significant indications of what’s going on and relate to all of our patients, not just Aetna,” Donoghue said.
He said the medical center wanted a P4P program that would be “portable and scalable” with NYU’s other payers, and for Aetna’s other providers.
The P4P pilot will extend for a little over three years. Aetna and NYU Medical Center both intend that continuous improvement will be made in each year of the program and for that reason performance goals and specific performance measures may be adjusted to reflect progress already achieved. Financial incentive payments will also vary from year to year based on the performance criteria being measured, the company said.
NYU Medical Center consists of NYU School of Medicine and NYU Hospitals Center facilities.
Aetna offers a broad range of traditional and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life, long-term care and disability plans, and medical management capabilities.
The five CMS Quality of Care Measures being used in this pilot include: Patients given appropriate beta blockers at discharge; Patients given ACE inhibitor or ARB for Left Ventricular Systolic Dysfunction; Pneumonia patients given initial antibiotics within four hours after arrival at the hospital; Surgery patients who received preventive antibiotics one hour before incision; Preventive antibiotics for surgery patients are stopped within 24 hours after surgery.
The Leapfrog Group Patient Safety Measures being used in this pilot include: Computer physician order entry — medication orders entered via computers linked to prescribing error prevention software (can reduce hospital-based prescribing errors by 50%); ICU staffing with physicians who have special training in critical care medicine (shown to reduce risk of patients dying by 40%); Leapfrog Safe Practices Score — assesses hospital’s progress on 27 additional safe practices endorsed by the National Quality Forum (can reduce risk of patient harm in certain processes, systems and environments of care).
In other contract news:
• Global Med Technologies (Denver) reported that Global Med’s Wyndgate Technologies division and Florida’s Blood Centers (FBC) have signed an agreement for the company’s Vein-to-Vein software, SafeTrace donor management, SafeTrace Tx advanced transfusion management, and ElDorado Donor Doc, Wyndgate’s newest software offering. With a value of several million dollars over a five-year period, Florida’s Blood Centers will be the largest user of Wyndgate’s Vein-to-Vein software on the East Coast.
FBC says it is the sole supplier of blood and blood products to 72 healthcare facilities in a 21-county area.
• Allscripts (Chicago) reported that Ochsner Health System (New Orleans) has selected it as their provider of an Electronic Health Record (EHR) and Practice Management (PM) solutions to help automate and connect clinical and administrative processes for their 600 physicians.
Allscripts also reported that Albany Medical Center (Albany, New York) has selected it as their EHR provider to automate clinical tasks for 250 physicians in their medical faculty group, and connect them to the organization’s hospitals.