Quality of Care Performance Measures

(5/8/15)- A pilot program that was set up under the Affordable Care Act saved Medicare almost $400 million over two years and is the first alternative-payment model shown to cut costs, while improving quality of care, according to the findings of independent actuaries.

As a result of the findings, the Pioneer Accountable Care Organization model becomes eligible to be expanded to a larger group of Medicare beneficiaries, as announced by officials from the Centers for Medicare and Medicaid Services (CMS).

Medicare beneficiaries make up about 3.5 million patients that are part of Affordable Care Organizations (ACOs) run by 400 health care systems.

Of the 600,000 patients in the Pioneer ACOs, an average of $36 less per month in 2012 and $11 less per month in 2013 per patient was saved for Medicare, than comparable non-affiliated patients. Pioneer patients also had fewer hospitalizations, used fewer tests, procedures and imaging services, and reported more timely care.

Pioneer met 28 of 33 quality metrics, and thus obtained certification from the CMS’s independent Office of the Actuary, resulting in entitlement to expand their program.

13 of the original 32 participating hospital systems dropped out or switched to other models after failing to meet performance standards

(6/21/11)- According to the federal Agency for Healthcare Research and Quality 4.4 million hospital stays are the result of potentially preventable re-admissions, which add more than $30 billion a year to the nation's health-care bill.

Beginning in 2012 Medicare plans to reduce how much it will pay hospitals for certain preventable re-admissions. In April, Medicare announced it would provide $500 million in grants for organizations that work with hospitals on programs to reduce re-admissions.

The federal government is funding an effort to help hospitals adopt Project RED (Re-Engineered Discharge), a discharge planning program developed by Boston University that helped cut re-admissions at Boston University Medical Center by 30% in a 2008 study.

The first cuts to reimbursement from Medicare will focus on congestive heart failure, heart attack and pneumonia, which account for the majority of re-admissions. You can check the re-admission rate at your local hospital by going to

(8/23/09)-Medicare officials announced that 225 hospitals would divide $12 million in bonuses that they earned under a pilot pay-for-performance program to help prevent infections in pneumonia patients and cut death rates in heart-attack patients. Three poor under performing hospitals will be penalized under the program.

Premier Inc., a health-information company that is Medicare's contractor on the project reported that the recipient hospitals saw about 4,700 fewer deaths among heart attack patients, in the four years ended September 30,2007 than if they had not participated in the program. There were 30 quality measures taken by these hospitals in which they scored high enough levels to earn the bonuses.

As an example, Premier said, 92.6% of the pneumonia patients received antibiotics, flu vaccines or other recommended treatments to prevent acquiring other infections in the hospital, up from 69.3%.

For more information on this topic, please see our item dated 5/25/05 below.

(2/8/07)- For the second year in a row the Hackensack University Medical Center received the most money from Medicare as a bonus for its quality of patient care in five designated areas. The five areas of comparison for the 266 hospitals involved in the program are: joint replacement, coronary artery bypass graft, heart attack, heart failure and pneumonia.

Performance bonuses were awarded in a total amount of $8.7 million to 115 of the hospitals involved in the program. Hackensack was the top performer in all 5 of the categories and received a total of $744,000 in bonuses. Premier Inc., a nonprofit hospital alliance, is managing the project.

The participating hospitals in the experiment are being measured on whether they give patients clear instructions when they leave the hospital on how best to stay healthy. The program will continue for one more year and then be reevaluated.

(5/20/05)- A coalition of clinicians, health plans and government officials have agreed on 26 quality measures for physicians offices that could help insurers set up performance-based payments as soon as next year. The coalition called the Ambulatory Quality Alliance measures includes items such as cancer screening and markers of overall use and abuse of services.

According to an analysis of the preliminary figures by the CMS of the 34 national standards that were set up to measure Medicare pay-for-performance, that involve 270 hospitals and 400,000 patients progress is being made in most if not all of the areas that were analyzed. The improvements included the following:

In a 3-year hospital demonstration project run by Premier Inc., a consortium of nonprofit health systems, hospitals can receive bonuses in Medicare payments based on a 34 national standard criteria. High performers can receive a bonus totaling $21 million over three years, while low performers could get up to a 2% reduction in their Medicare payments.

It is obvious at this point that quality-of-performance measures that are being endorsed by President Bush's administration is the wave of the future. The big question mark at this point is whether or not it is something that truly will improve the overall treatment of all patients??


By Allan Rubin
updated May 8, 2015

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