MHA's Executive Briefing

Investing in Nurse Communication Pays Dividends in HCAHPS Scores

A recent report by Press Ganey identified communication with nurses as a "rising tide" patient experience measure — one that influences a host of other HCAHPS measures, including responsiveness of hospital staff, communication about medication and overall patient experience scores. Hospitals could potentially affect 15 percent of their Value-Based Purchasing incentive payments by focusing their improvement efforts on the nurse communication metric, according to Press Ganey's research findings.

Learn more here.

HCA going undercover to spot service flaws

The chief executive officer of an HCA-owned (HCA) hospital recently went undercover, wearing a two-day- old beard and a baseball cap to pose as a patient entering his hospital. His goal: spot service flaws and get them fixed.

Read more from Bloomberg here.

From Volume to Value, by 2020?

Suzanne Delbanco, executive director of Catalyst for Payment Reform, sits down with H&HN contributing editor Bob Kehoe to discuss the organization's vision for spreading value-based payment, and moving away from fee-for-service reimbursement, over the next decade.

Watch the video here.

Study: Payment penalties aren’t responsible for declining hospital infections

Hospital infection rates continue to fall, but Medicare payment penalties have not contributed to the result, according to a study in the Oct. 11 New England Journal of Medicine. “In this national evaluation of the effect of the 2008 [Centers for Medicare & Medicaid Services] policy to reduce additional payments for preventable hospital complications, we did not find any effect on rates of targeted healthcare-associated infections as measured with the use of clinical data,” the authors report.

The study found a strong downward trend for targeted infections well before the implementation or announcement of the CMS policy, with no measurable additional benefit of the policy. “As CMS continues to expand this policy to cover Medicaid through the Affordable Care Act, require public reporting of [National Healthcare Safety Network] data through the Hospital Compare website, and impose greater financial penalties on hospitals that perform poorly on those measures, careful evaluation is needed to determine when these programs work, when they have unintended consequences, and what might be done to improve patient outcomes,” the study concludes.

[ via AHA News Now ]

Board's Eye View: Preparing for Value-Based Purchasing

The Medicare value-based purchasing (VBP) program is an initiative described in the Affordable Care Act whose purpose is to provide a practical means to reduce costs to the nation’s healthcare system while improving quality of care. Hospitals that achieve the highest total performance scores (TPSs) under this program’s scoring methodology can earn incentive payments for performance excellence.

Read more from HFMA here.

Study looks at impact of changes in pay-for-performance demonstration

Rewarding quality improvement may not generate greater improvement among lower performing hospitals, according to a study published April 9 in Health Affairs. The study found no evidence that hospitals in the lowest initial quartile of performance of the Premier Hospital Quality Incentive Demonstration improved their performance after the Medicare demonstration added quality improvement incentives to the existing incentives for attaining certain performance levels.

"We estimate that the change in incentive design provided the strongest financial incentive not to hospitals with the lowest initial quality, but to hospitals whose initial quality was just above the median," the authors state. "However, these hospitals did not improve disproportionately more in phase 2 than hospitals in the other quartiles of initial quality."

5 Ways to Make the Pay-for-Performance Transition Smoother

Medicare will soon begin reimbursing hospitals based, at least somewhat, on their performance. As such, hospitals will be compensated based on certain measures such as quality outcomes and readmission rates. Making the transition to pay-for-performance necessitates an entire culture change focused on the collaboration between hospital administration, physicians and staff. Here are five ways hospitals can make the transition smoothly.

Senators release discussion draft of value-based purchasing bill

Senate Finance Committee Chairman Max Baucus (D-MT) and Ranking Member Charles Grassley (R-IA) on Nov. 19 issued a discussion draft of legislation that would begin a Medicare value-based purchasing program for inpatient hospital care in fiscal year 2012. The draft legislation would increase or decrease Medicare payments depending on how much a hospital improved annually or how frequently it met certain quality measures chosen by the Health and Human Services secretary. The secretary is encouraged but not required to choose measures endorsed by the National Quality Forum and adopted by the Hospital Quality Alliance, beginning with measures for heart attack, heart failure, pneumonia, surgical care and overall patient experience.

The program would be budget neutral, using decreased payments to some hospitals to pay for increased payments to others. The total payment adjustment would grow from 1% in FY 2012 to 2% by FY 2016. “While we support moving forward with a VBP plan, we remain concerned about many of the details,” said Tom Nickels, American Hospital Association senior vice president for federal relations. “Issues such as the broad discretion provided to HHS, the total amount of payments at risk and the process for identifying measures need to be addressed before a workable program can be adopted.”

[ via AHA News Now ]

Treating sicker patients may hurt hospitals' P4P

Hospitals that treat lower-income, sicker patients may not be evaluated fairly in pay-for-performance programs, according to a study published in the Journal of the American Medical Association.

Using data on treatment of more than 148,000 heart attack patients at 449 hospitals provided by the American Heart Association’s “Get with the Guidelines” coronary artery disease program, the study’s authors ranked hospitals into three performance categories. The performance measures were similar to those used by the CMS.

Hospitals ranked in the top 20% were likely to receive incentive payments, the middle 60% would get no incentives, and the bottom 20% would get payment reductions.

But when the researchers adjusted the data to account for patient mix and quality reporting, the hospital rankings shifted modestly. They found that most low-performing hospitals in the original rankings were smaller or nonacademic, with larger numbers of patients from racial or ethnic minority groups who had diabetes, heart failure, chronic atrial fibrillation and other conditions.

“Our study reveals the need to level the playing field, so hospitals serving more minority, elderly, sick or uninsured patients can compete fairly with others,” Eric Peterson, senior author of the study and director of cardiovascular research at Duke Clinical Research Institute, said in a statement.

[ via Rebecca Vesely, Modern Healthcare's Daily Dose ]

Hospital pay-for-performance bill introduced in House

Rep. Jason Altmire (D-PA) on Sept. 26 introduced legislation that would implement a pay-for-performance program for Medicare inpatient hospital payments beginning in fiscal year 2011. The Quality FIRST Act (H.R. 7067) would adjust inpatient payments for hospitals based on quality benchmarks announced in FY 2009.

Hospitals that met the benchmarks or improved their performance would receive an annual payment increase for certain diagnosis-related groups. The “value-based” payment system would be phased in over four years.

The program would start with the current Hospital Quality Alliance inpatient measures for heart attack, heart failure, pneumonia and surgical care, and require any new measures to be endorsed by the National Quality Forum and recommended by the HQA. The bill would require ongoing evaluation of the program.

[ via AHA News Now ]