Data reporting. Premier's Perspective database tracked hospital performance in several clinical areas and was already in place before. HQID started. From 2003 ...
Appendix 1 Characteristics of the Hospital Quality Incentive Demonstration and Value-Based Purchasing Programs HQID5,8 Voluntary, Premier Inc. acute care hospitals with Medicare patients
VBP8 Obligatory, all acute care hospitals outside of Maryland with Medicare patients
Time period Size of bonus or penalty
2003 quarter 4 to 2009 quarter 4 1% (Phase 1)-2% (phase 2) of Medicare payments as bonus or penalty
Ongoing since 2011 quarter 3 1.75-2% of Medicare payments as bonus or penalty
Target conditions
AMI, CHF, PNA, Coronary Artery Bypass Graft and total knee or hip replacement
AMI, CHF and PNA
Performance domains and measures
Clinical process scores and patient outcomes (mortality)
Clinical process scores and later patient experience, patient outcomes (mortality) and efficiency, see table below.
Basis for the bonus or penalty
Hospitals scoring in the highest or second highest (or lowest for penalty) decile while in Phase 2 there was also a reward for improvement i.e. for hospitals in the top two deciles of improvers.
Achievement (level) and improvement (relative change) scores where the higher of the two determines the hospitals score.
Data reporting
Premier's Perspective database tracked hospital performance in several clinical areas and was already in place before HQID started. From 2003 onwards National Voluntary Hospital Reporting Initiative, all acute care hospitals were invited. In 2005 the first set of process measures was displayed through Hospital Compare and this was expanded from 2008 onwards with outcomes and patient experience, resulting in a participation rate of 98%.
From 2003 onwards National Voluntary Hospital Reporting Initiative, all acute care hospitals were invited. In 2005 the first set of process measures was displayed through Hospital Compare and this was expanded from 2008 onwards with outcomes and patient experience, resulting in a participation rate of 98%.
Clinical process scores
AMI
AMI
Participating hospitals
Aspirin within 24 hours of arrival (if no contraindications) Aspirin prescribed at discharge (if no contraindications). Angiotensin converting enzyme inhibitor (ACEI) or (after 10/01/05) angiotensin receptor blocker (ARB) prescribed at discharge for left ventricular Systolic Dysfunction (LVSD) if no contraindications. Adult smoking cessation advice or counseling during hospital
Heart attack patients given a prescription for a statin at discharge Heart attack patients given aspirin at discharge Heart attack patients given fibrinolytic medication within 30 minutes of arrival Heart attack patients given PCI within 90 minutes of arrival Outpatients with chest pain or possible heart attack who got drugs to break up blood clots
stay for patients who have smoked in the past year. Beta blocker prescribed at discharge (if no contraindications). Beta blocker prescribed within 24 hours of arrival (if no contraindications). Thrombolytic agent within 30 minutes of arrival (if thrombolysis within six hours). Percutaneous Coronary Intervention (PCI) within 120 minutes (90 minutes after 7/01/06) of admission (if PCI within 24 hours). Inpatient survival index for adult AMI patients.
CHF
PNA
Left ventricular function (LVF) assessment performed or planned. Written discharge instructions covering activity level, diet, discharge medications, follow-up appointment, weight monitoring, and what to do if symptoms worsen. Angiotensin converting enzyme inhibitor (ACEI) or (after 10/01/05) angiotensin receptor blocker (ARB) prescribed at discharge for left ventricular Systolic Dysfunction (LVSD) at discharge (if no contraindications). Adult smoking cessation advice or counseling during hospital stay for patients who have smoked in the past year.
Arterial blood gas or pulse oximetry with 24 hours before or after arrival. Initial antibiotic regimen consistent with current guidelines during the first 24 hours (if
CHF
within 30 minutes of arrival Outpatients with chest pain or possible heart attack who got aspirin within 24 hours of arrival Median Time to Fibrinolysis Average number of minutes before outpatients with chest pain or possible heart attack got an ECG Average number of minutes before outpatients with chest pain or possible heart attack who needed specialized care were transferred to another hospital Heart attack patients given a prescription for a statin at discharge Higher percentages are better Heart attack patients given aspirin at discharge Heart attack patients given fibrinolytic medication within 30 minutes of arrival Heart attack patients given PCI within 90 minutes of arrival Outpatients with chest pain or possible heart attack who got drugs to break up blood clots within 30 minutes of arrival Outpatients with chest pain or possible heart attack who got aspirin within 24 hours of arrival Median Time to Fibrinolysis Average number of minutes before outpatients with chest pain or possible heart attack got an ECG Average number of minutes before outpatients with chest pain or possible heart attack who needed specialized care were transferred to another hospital
Heart failure patients given discharge instructions Heart failure patients given an evaluation of left ventricular systolic (LVS) function Heart failure patients given ACE
antibiotics within 36 hours). Initial blood culture prior to the first hospital administration of antibiotics. Influenza vaccination for pneumonia patients aged 50 or older discharged during Oct. through Feb. (Suppressed for FY2005 and the first quarter of FY2006 due to vaccine shortage.) Pneumococcal vaccination for patients aged 65 or older. Initial antibiotic within 4 hours of PNA arrival if received antibiotics within 24 hours. Adult smoking cessation advice or counseling during hospital stay for patients who have smoked in the past year.
inhibitor or ARB for left ventricular systolic dysfunction (LVSD) Heart failure patients given discharge instructions Heart failure patients given an evaluation of left ventricular systolic (LVS) function Heart failure patients given ACE inhibitor or ARB for left ventricular systolic dysfunction (LVSD)
Pneumonia patients whose initial emergency room blood culture was performed prior to the administration of the first hospital dose of antibiotics Pneumonia patients given the most appropriate initial antibiotic(s) Pneumonia patients whose initial emergency room blood culture was performed prior to the administration of the first hospital dose of antibiotics Pneumonia patients given the most appropriate initial antibiotic(s)
