Healthcare Quality Metrics
Hospital executive leadership are dedicated to the mission that patients expect and deserve the excellent care from their health care providers. The Centers for Medicare & Medicaid Services (CMS) is the driving force behind the delivery of quality care, and ensuring that healthcare insurance remains accessible and affordable to the public. In order for leadership to advance CMS’s mission; they may need look outside the organization for real solutions in reducing their hospital-acquired conditions and improve their quality scores.
Section 3008 of the Patient Protection and Affordable Care Act (ACA) established three programs that can affect the Hospital Inpatient Prospective Payment System (IPPS). The Hospital-Acquired Condition (HAC) Reduction Program provides an incentive for hospitals to reduce HACs. The effective fiscal year was 2015 that targeted discharges beginning in October 2014. The HAC reduction program requires an adjustment to payments to hospitals of 1% that rank in the worst performing quarter. In 2017 HAC Reduction program, hospitals with a total HAC score greater than 6.577 are subject to a payment reduction. (‘CMS’, 2016, para.2)
The ACA also established the Value Based Purchasing Program that offers incentives to hospitals based on:
Those measures would include:
CMS makes rate adjustment reduction when the facility falls below benchmark, the reduction started at 2013 at 1% to 2017 at 2%. The organizations that exceed benchmarks will realize a bonus of up to 2% in 2017 that is funded by those organizations who were penalized.
Hospital Readmission Reduction Program that was also mandated by the ACA. In this program there is no incentive for meeting the requirements only penalties for thirty-day readmission for:
“If the Readmissions Adjustment Factor is 1.000, there is no payment reduction. Any number between .9999 and .9700 would trigger a payment reduction.” (NQF, 2016, para.10) The reduction rate is currently 3% and for future fiscal years, but that is subject to change.
Given the penalties that could be applied to an organization, it is very worthwhile for the executive leadership to take a proactive approach to improving their quality reporting.
One are to focus on is the institution’s HACs and how those conditions affect the institutions quality scores and of course to their bottom line. CMS publishes hospitals and provider scores for competitors and consumers to review. Would a potential patient choose a provider that has a score of 6.577 or greater for Surgical Site Infections to perform their hip replacement? HQM Consulting can provide solutions to your organization that addresses quality outcomes through a very targeted process.
If your organization has landed in the lowest quartile and/or have a quality score of 6.577 or greater in any service line, HQM Consulting can assist the executive leadership to identify and to document the service lines, providers and nursing units that are under performing.
HQM Consulting will develop benchmarks and provide cost effective strategies to facilitate change; as simple as workflow re-design. HQM has proven strategies that can improve quality outcomes and increase reimbursements that help ensure the success of the organization.
Home. (n.d.). Retrieved December 27, 2016, from https://www.cms.gov/
NQF: Home. (n.d.). Retrieved December 27, 2016, from http://www.qualityforum.org/Home.aspx
Overview. (n.d.). Retrieved December 27, 2016, from http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/hospital-value-based-purchasing/index.html