Medicare program to reward hospitals for quality care
The U.S. Department of Health and Human Services has launched a program that will reward hospitals for providing high-quality care to Medicare patients and reducing health care costs.
Authorized by the Affordable Care Act, the Hospital Value-Based Purchasing program marks the beginning of a change in how Medicare pays health care providers and facilities. For the first time, 3,500 hospitals across the country will be paid for inpatient acute care services based on care quality, not just the quantity of the services they provide.
Columbia’s two major health care systems — University of Missouri Health Care and Boone Hospital Center — appear to be on track to qualify for the program funding, according to hospital officials and Primaris, a state-affiliated quality improvement organization based in Columbia.
The program helps support the goals of the Partnership for Patients, a new public-private partnership that aims to improve the quality, safety and affordability of health care for all Americans. The Partnership for Patients says it has the potential over the next three years to save 60,000 lives and save up to $35 billion in health care costs, including up to $10 billion for Medicare. Over the next 10 years, the partnership says the program could reduce costs to Medicare by about $50 billion and result in billions more in Medicaid savings.
The U.S. spends almost $6.2 billion per day on health care costs, according to the Kaiser Family Foundation. And 20 percent of those costs, according to the Department of Health and Human Services, are covered by Medicare.
In 2013, an estimated $850 million will be allocated to hospitals based on their overall performance on a set of quality measures that have been shown to improve clinical processes of care and patient satisfaction. This funding will be taken from what Medicare otherwise would have spent, and the size of the fund will gradually increase over time and result in a shift from payments based on volume to payments based on performance.
The better a hospital does on its quality measures, the greater the reward it will receive from Medicare.
Cora Butler, director of business development and commercial-contract administration at Primaris, said MU Health Care and BHC display characteristics consistent with criteria that the Centers for Medicare and Medicaid Services has established for improved quality of patient care. The criteria were based on a study of 260 hospitals that CMS conducted in 2002-06 with nationwide hospital system Premier Inc.
The study showed that in terms of quality of care, health care systems that were located in competitive markets that were well financed and fiscally responsible and that were accredited by multiple health care accreditation organizations such as The Joint Commission provided a higher level of patient care.
“Columbia’s two health care systems have incorporated evidence-based practices into their processes, so they pretty well follow that profile and should do well with Medicare’s pay-for-performance program,” Butler said.
MU Health Care already has strong quality and patient satisfaction programs that emphasize outcomes and innovations in health care delivery, spokesman Jeff Hoelscher said. “For that reason, we expect that we’ll be receiving incentive payments to offset the proposed across-the-board cut in Medicare reimbursement,” he said. “However, it is too early to tell how much the incentive payments will offset the across-the-board cut in Medicare reimbursement.”
MU Health Care, which operates University Hospital and Clinics, invests nearly $4.6 million annually to support quality initiatives coordinated by its Office of Clinical Effectiveness and its Center for Health Care Quality and other departments within the health system.
Hoelscher said one example of guidelines that MU Health Care follows relates to the prevention of urinary tract infections. Sometimes a surgical patient needs to have a urinary catheter, a thin tube inserted into the bladder to help drain urine. Medical research shows that most surgery patients should have their urinary catheters removed within two days after surgery to help prevent infections.
The most recent data reported by CMS indicates that 94 percent of MU Health Care surgery patients had their urinary catheters removed on the first or second day after surgery. This data compares with state rates of 88 percent and national rates of 90 percent.
Boone Hospital Center also is closely following the development of the Value-Based Purchasing program. BHC spokesman Jacob Luecke said that, as a Thomson Reuters 100 Top Hospital and a Magnet Hospital for Nursing Excellence, Boone Hospital has a long tradition of focusing on safety as a top priority, seeking out evidence-based practices and continually working to bring the best possible care to our patients.
“Because of this tradition, Boone Hospital is not planning any specific care changes in response to the government’s new purchasing plan,” Luecke said. “We are already recognized a top performer and anticipate doing well under the new program. Our concern lies with the rural hospitals in our region that may not have the same financial resources and could be adversely impacted by any payment reduction.”
Butler said that Primaris is helping hospitals navigate through the changes brought about by Medicare’s Value-Based Purchasing program by first focusing on process improvements.
“CMS is looking at the whole picture of the complex issue of increasing the quality of patient care while reducing health care costs,” she said. “Pay for performance is one more way for Medicare and health care systems to make sure that they are delivering the right care at the right time for the right cost.”
Authorized by the Affordable Care Act, the Hospital Value-Based Purchasing program marks the beginning of a change in how Medicare pays health care providers and facilities. For the first time, 3,500 hospitals across the country will be paid for inpatient acute care services based on care quality, not just the quantity of the services they provide.
Columbia’s two major health care systems — University of Missouri Health Care and Boone Hospital Center — appear to be on track to qualify for the program funding, according to hospital officials and Primaris, a state-affiliated quality improvement organization based in Columbia.
The program helps support the goals of the Partnership for Patients, a new public-private partnership that aims to improve the quality, safety and affordability of health care for all Americans. The Partnership for Patients says it has the potential over the next three years to save 60,000 lives and save up to $35 billion in health care costs, including up to $10 billion for Medicare. Over the next 10 years, the partnership says the program could reduce costs to Medicare by about $50 billion and result in billions more in Medicaid savings.
The U.S. spends almost $6.2 billion per day on health care costs, according to the Kaiser Family Foundation. And 20 percent of those costs, according to the Department of Health and Human Services, are covered by Medicare.
In 2013, an estimated $850 million will be allocated to hospitals based on their overall performance on a set of quality measures that have been shown to improve clinical processes of care and patient satisfaction. This funding will be taken from what Medicare otherwise would have spent, and the size of the fund will gradually increase over time and result in a shift from payments based on volume to payments based on performance.
The better a hospital does on its quality measures, the greater the reward it will receive from Medicare.
Cora Butler, director of business development and commercial-contract administration at Primaris, said MU Health Care and BHC display characteristics consistent with criteria that the Centers for Medicare and Medicaid Services has established for improved quality of patient care. The criteria were based on a study of 260 hospitals that CMS conducted in 2002-06 with nationwide hospital system Premier Inc.
The study showed that in terms of quality of care, health care systems that were located in competitive markets that were well financed and fiscally responsible and that were accredited by multiple health care accreditation organizations such as The Joint Commission provided a higher level of patient care.
“Columbia’s two health care systems have incorporated evidence-based practices into their processes, so they pretty well follow that profile and should do well with Medicare’s pay-for-performance program,” Butler said.
MU Health Care already has strong quality and patient satisfaction programs that emphasize outcomes and innovations in health care delivery, spokesman Jeff Hoelscher said. “For that reason, we expect that we’ll be receiving incentive payments to offset the proposed across-the-board cut in Medicare reimbursement,” he said. “However, it is too early to tell how much the incentive payments will offset the across-the-board cut in Medicare reimbursement.”
MU Health Care, which operates University Hospital and Clinics, invests nearly $4.6 million annually to support quality initiatives coordinated by its Office of Clinical Effectiveness and its Center for Health Care Quality and other departments within the health system.
Hoelscher said one example of guidelines that MU Health Care follows relates to the prevention of urinary tract infections. Sometimes a surgical patient needs to have a urinary catheter, a thin tube inserted into the bladder to help drain urine. Medical research shows that most surgery patients should have their urinary catheters removed within two days after surgery to help prevent infections.
The most recent data reported by CMS indicates that 94 percent of MU Health Care surgery patients had their urinary catheters removed on the first or second day after surgery. This data compares with state rates of 88 percent and national rates of 90 percent.
Boone Hospital Center also is closely following the development of the Value-Based Purchasing program. BHC spokesman Jacob Luecke said that, as a Thomson Reuters 100 Top Hospital and a Magnet Hospital for Nursing Excellence, Boone Hospital has a long tradition of focusing on safety as a top priority, seeking out evidence-based practices and continually working to bring the best possible care to our patients.
“Because of this tradition, Boone Hospital is not planning any specific care changes in response to the government’s new purchasing plan,” Luecke said. “We are already recognized a top performer and anticipate doing well under the new program. Our concern lies with the rural hospitals in our region that may not have the same financial resources and could be adversely impacted by any payment reduction.”
Butler said that Primaris is helping hospitals navigate through the changes brought about by Medicare’s Value-Based Purchasing program by first focusing on process improvements.
“CMS is looking at the whole picture of the complex issue of increasing the quality of patient care while reducing health care costs,” she said. “Pay for performance is one more way for Medicare and health care systems to make sure that they are delivering the right care at the right time for the right cost.”