Medical Device Daily Washington Editor

Quality improvement efforts continue to roll, and a contractor with the Centers for Medicare and Medicaid Services with experience in pay-for-performance (P4P) programs has teamed up with a non-profit research organization to put in place a new program for quality improvement that may have to compete with other such programs already in place.

In a conference call yesterday to unveil the program, Premier (Charlotte, North Carolina), the hospital consortium that is handling the P4P contract for CMS, and the Institute for Healthcare Improvement (IHI; Cambridge, Massachusetts) said they are co-sponsoring a quality initiative dubbed QUEST (Quality, Efficiency, Safety with Transparency), which will run for three years in at least 100 hospitals, all of which will gauge their performances in five areas.

During the first year, each participating hospital will measure its performance in three of the areas —mortality ratios, appropriateness of care and efficiency — while the final two measures — harm avoidance and patient satisfaction — will come into play in the second year.

The mortality ratio will be adjusted for risk, while the appropriateness-of-care will be determined by the percentage of patients who received "perfect care," as defined by national standards. Efficiency will be gauged by an adjusted cost-per-discharge, while the harm avoidance measurement "will be developed over time by the cohort and will likely parallel the IHI 5 Million Lives campaign," according to the QUEST web site.

Patient satisfaction will be measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) mechanism developed by the Agency for Healthcare Research and Quality (AHRQ; Washington).

During the conference call, Richard Norling, president/CEO of Premier, said QUEST "is based on the same principals" as Hospital Quality Incentive Demonstration (HQID), HQID being the formal name of the P4P program that Premier hospitals are conducting for CMS. He said that the success of that effort "led us to the belief that the same principals" could be used to improve quality and reduce costs at other hospitals, even without government involvement.

As for the question of whether hospitals might be overwhelmed with quality projects, Norling said that the feedback he got from hospitals indicated that "these five steps are absolutely in line with their strategic priorities," adding that the program was designed with the feedback from those hospitals in mind.

Norling described QUEST as "not a cumbersome add-on, but a strategic focal point."

Norling's comments seem to be buttressed by a an interesting recruiting dilemma that the QUEST program now faces: while the planners initially envisioned that only 100 hospitals would participate, more than 500 have expressed an interest in it.

On the other hand, the question remains as to whether improved care will result in cost savings.

In its Jan. 24 report on two-year data from the CMS pilot project, Premier reported impressive results for rural hospitals, but Alven Weil, Premier's public relations manager for informatics, said at the time that the bonus money did not cover the cost of improved care for the majority of the participating rural hospitals (Medical Device Daily, February 2).

The organizations will complete their recruitment of hospitals by Sept. 30.

CHIP seen chipping away at Medicare

The House Ways and Means Committee recently introduced the Children's Health and Medicare Protection (CHAMP) Act of 2007 to some fanfare by the majority party congressional membership. But at least one association finds the bill's provisions troubling for seniors.

The American Health Care Association (AHCA; Washington) issued a statement yesterday urging House Democrats to rewrite the bill "in a way to avoid dramatic and negative consequences to the current and future care needs of America's most vulnerable seniors."

By AHCA's accounting, the bill could "jeopardize the stability of funding for nursing home care" and would "slash seniors' Medicare funding by more than $500 million."

Bruce Yarwood, president/CEO of AHCA said in the statement: "the House leadership and the Ways and Means Committee [intent] to cut Medicare-funded long-term care disregards the current and future care needs of America's most vulnerable seniors."

Among the bill's provisions is a section that deals with long-term care hospitals (LTCHs), which the summary states would impose "a four-year moratorium on the development of new LTCHs and expansion of existing LTCHs to address concerns about growth." The bill would also freeze payment rates for calendar year 2008.

Congress and the Medicare Payment Advisory Commission (MedPAC; Washington) have kept an eye on LTCHs due to perceptions of abuse. Both houses of Congress inked bills titled the Medicare Long-Term Care Hospital Improvement Act (Medical Device Daily, Jan. 26, 2007), but the Senate version, S. 338, is stuck in the Finance Committee despite sponsorship by the committee chair, Kent Conrad (D-North Dakota).

The House version, H.R. 562, suffers essentially the same fate in the Ways and Means Committee.

In testimony before the House Ways and Means Committee in March 2006, MedPAC's executive director, Mark Miller, told legislators that Medicare payments to LTCHs jumped from $398 million in 1993 to roughly $3.3 billion in 2004. CMS reportedly estimated at the time that it would pay out more than $5 billion in calendar year 2007, and the rapid growth of long-term care hospitals that operate within a general-care hospital — the so-called "a hospital-within-a-hospital" configuration — has stimulated a lot of concern among policymakers due to the fact that these units grew at twice the rate of freestanding LTCHs.

The bill would also freeze payment rates for skilled nursing facilities, which provoked AHCA's comments regarding nursing home care.