A program that provides financial incentives to hospitals that meet quality of care standards has been financially restructured and extended three years by the Centers for Medicare and Medicaid Services.
Premier Inc's Hospital Quality Incentive Demonstration, under which top-performing hospitals have received cash rewards for quality improvements, has been modified to make more participating hospitals eligible for rewards.
More than 250 participating hospitals throughout the United States have made efforts to improve care quality for their fee-for-service Medicare patients under HQID, but only those in the top 20 percent of quality performance have received funds during the first two years of the program.
A new three-level financing structure will take effect as CMS evaluates the hospitals in the coming years. The top 20 percent will still be rewarded, but now an attainment award will go to hospitals that exceed the median level of performance established two years ago. Also, lower-performing hospitals that make considerable quality improvements will receive incentives.
Mark Wynn, director of CMS's Division of Payment Policy Demonstrations, said the original structure of HQID didn't provide enough incentives to those average hospitals that took measure to improve. "We're spreading the money around a little more and trying to help those hospitals that have stepped up to make those improvements," Wynn said.
CMS also will increase the funding for the program under the new structure. In the coming year, roughly $12 million will be awarded. By contrast, in the first two years of the program, the agency awarded $8.9 million and $8.7 million, respectively.
Only the hospitals that are already participating are eligible to continue in HQID, said Wynn. He added that some hospitals may resign from the demonstration in its coming years.
The program targets and sets standards for five high-volume diseases – acute myocardial infarction; heart failure; coronary artery bypass graft; community-acquired pneumonia; and hip and knee replacement. Wynn said CMS is looking to expand the demonstration to other areas, such as mortality and patient safety measures.
"CMS is starting to require some surgical complication measures," he added. "We're taking a careful look at whether we could improve that in the future."
Denise Dominik, RN, director of performance improvement at Spokane, Wash.-based Sacred Heart Medical Center, said her hospital was the fourth-highest reward recipient in HQID's second year. Sacred Heart received nearly $257,000 for its adherence to quality standards in four of the five areas of care.
"My goal is to have reimbursement for all five," Dominik said. She said Sacred Heart has difficulties in the area of community-acquired pneumonia, because of the large number of physicians who are involved in its treatment.
"One of the things we're doing a little differently is we look at an appropriate care measure score, making sure every patient gets the right treatment at the right time, every time," Dominik said. "I think that will be the future of pay for performance."
While signing up for HQID doesn't cost anything, there are costs associated with setting up a structure to improve quality, Dominik noted. And while she stressed that the goal of the program is to improve care for the patient, Dominik said the financial rewards are welcome. "Money is always good," she said. "Nobody will say it's bad in healthcare."