The Centers for Medicare and Medicaid Services is trying to enlist Premier, one of the leading hospital alliances, in a new federal effort to link hospital reimbursements to quality of care, Modern Healthcare has learned.
As part of HHS Secretary Tommy Thompson's focus on consumer-oriented outcomes, the CMS is creating patient-satisfaction surveys and quality measurements for hospitals, as it already has done for other provider groups such as nursing homes. Ultimately, the CMS would like to tie hospital payments to quality performance, CMS Administrator Thomas Scully said.
"People who perform better will be paid more," Scully told Modern Healthcare in an exclusive interview last week.
Scully said he has discussed working on a joint demonstration project with Premier, an alliance that represents roughly 1,600 hospitals. Premier collects clinical and financial information voluntarily submitted by more than 500 of its member hospitals. The database would provide 95% of the quality-measurement information HHS is interested in tracking, Scully said.
So far, Premier said it has not committed to any plan. "We're trying to listen to what the CMS wants to accomplish. Nothing's been put on paper yet," said Herb Kuhn, corporate vice president of advocacy at Premier. "We want to respond to their proposals."
Scully said the CMS proposal is in a conceptual stage but also said he has floated it to other provider groups that he declined to name besides Premier.
"If they don't do it, I'll find someone else," Scully said. "It is going to happen."
He did not give a specific time frame for the quality-reimbursement demonstration project and said he would start it "as soon as I get a bite. I've got to get someone to do it first."
Mitchell Levy, M.D., medical director of 719-bed Rhode Island Hospital in Providence, said he supports a demonstration project for tying quality to reimbursement but warned that a nationwide rollout would be premature and fraught with potential measurement errors.
"First let's get hospitals and clinicians to embrace quality measurements. Let's study the process and refine it," said Levy, who sits on a quality advisory board for the Joint Commission on Accreditation of Healthcare Organizations.
The CMS plans to ease hospitals into standardized quality measurements in a voluntary initiative that it plans to launch in the next several months. The agency will publish quality data for individual hospitals in a manner similar to its recent nursing home quality initiative (April 22, p. 12).
The reporting will be voluntary at first but is expected to become mandatory in a couple of years, Scully said. "The goal is to get a comfort level," he said.
Hospital groups, including the American Hospital Association and the Federation of American Hospitals, have been on board with the CMS as it works on developing standardized measurements, Scully said.
"The challenge here is not the objective and the goal," said Carmela Coyle, the AHA's senior vice president of policy. "What we have to get down to is what are the measures."
The AHA supports sharing quality measures and information with the public as long as they are "meaningful and valid and comparable," Coyle said. Creating measurements that patients can understand is another concern. "If it's sharing data and not sharing information, there could be a potential to mislead consumers," Coyle said. "We want to avoid that."
Scully said the agency is looking at what data hospitals already collect for themselves and report to the JCAHO. "We don't want to spook hospitals," Scully said. "We want to be fair, accurate and constructive."
The CMS is rolling out a nationwide, mandatory nursing home quality initiative in November and will unveil a mandatory home health initiative next year.
In the meantime, the CMS has put public reporting of hospital patient satisfaction surveys on the fast track and hopes to have a standardized survey by midwinter. "We're in a hurry to do that," Scully said.
The CMS has asked HHS' Agency for Healthcare Research and Quality to develop questions for the surveys. Comments from the healthcare community are due by Sept. 23. The next step will be to go through the list of questions with stakeholders, including the CMS and provider groups, this fall and publish a draft form as early as January, said Charles Darby, an AHRQ project officer working on the survey.