Following quality measures in treating patients saved lives and money in four of five disease types, according to results of a joint government-private sector pay-for-performance project.
Extrapolating results from the Hospital Quality Incentive Demonstration project from 250 participating hospitals to all of the country's hospitals could mean 5,700 fewer deaths and savings of as much as $1.35 billion annually.
Wider adoption of such evidence-based methodologies will require healthcare organizations to use information technology that can bring caregiving guidelines and patient information to the point of care, study organizers said.
The analysis was based on data from the project, which was operated by Premier Inc., a Charlotte, N.C.-based healthcare alliance, the Institute for Healthcare Improvement and the Center for Medicare and Medicaid Services.
Under the demonstration project between CMS and Premier, hospitals performing in the top 20 percent of all facilities in documented adherence to care protocols are eligible for additional payment from Medicare.
Last month, CMS reported that it paid $8.9 million to 123 hospitals that qualified under the incentive system. Payments per diagnosis ranged from $1.1 million for pneumonia cases to $2.1 million for knee replacements.
Top performers included small and large providers, said Mark Wynn, director of payment policy demonstrations for CMS' Office of Research, Development and Information.
The final results of the initial phase of the program confirmed early results announced in June from analysis of pneumonia treatment and coronary artery bypass graft procedures.
Recent analysis of heart attack and hip and knee replacement procedures also found that following optimal care processes saved lives and money.
However, improving care processes resulted in higher treatment costs for patients with chronic heart failure, said Denise Remus, vice president for clinical informatics for Premier.
She theorizes that clinicians who followed the processes were more likely to prescribe more interventions for patients. For example, in providing more ventric assessment, clinicians were more likely to request echocardiograms.
Further study is needed to determine how process improvements affect the treatment of chronic conditions, Remus said. It's possible that slightly longer or more costly initial stays might prevent costly treatment or re-admissions down the road, thus reducing overall healthcare expenditures.
In the four areas in which quality measures were effective - pneumonia, heart bypass, heart attack and hip and knee replacement - those measures, if widely adopted in 2004, would have resulted in nearly 5,700 fewer deaths, 8,100 fewer complications, 10,000 fewer re-admissions and 750,000 fewer hospital days.
The project is entering its third year. Clinical data collected in the first year set the baseline for performance. Premier continues to collect data monitoring hospital progress toward implementing various evidence-based care protocols.
The project is using data from about 77,000 patients in Premier's Perspective data warehouse, a national clinical database used by more than 500 hospitals for benchmarking and quality improvement.