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Avera Quality Background

CMS / Premier Hospital Quality Incentive Demonstration

CMS, with Premier, Inc., is involved in a three-year demonstration project. The project uses a set of standards to measure individual hospital quality performance. The purpose of this demonstration is to improve quality and efficiency of patient care and to test the impact of economic incentives on quality.

Participating hospitals volunteered to have their quality data on five high-volume clinical conditions analyzed in a standard way. Each year, Medicare will pay top performers more for delivering high-quality health care. In addition, Medicare will publish the quality data from the top 50 percent of participants. Hospitals that perform in the top decile (10 percent) will receive a 2 percent bonus on their base Medicare DRG payments for the given clinical condition(s). Performers in the next decile will receive a 1 percent bonus on their base Medicare DRG payments in the given clinical condition(s).

Hospitals that subscribe to Premier’s Perspective ™ clinical comparative database could participate in the demonstration. They will compete for top-performer recognition and receive regular comparative reports on the quality of care for the five medical conditions. Data will be analyzed using consistent, standard methods. Because the health of patients varies, measures will use adjustment methods to allow for a fair comparison.

 

Hospital Consumer Assessment of Healthcare Providers and Systems

The intent of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS pronounced H-Caps) initiative is to provide a standardized survey instrument and data collection methodology for measuring patients' perspectives on hospital care. While many hospitals currently collect information on patients' satisfaction with care, there is no national standard for collecting or publicly reporting this information that would enable valid comparisons to be made across all hospitals. In order to make "apples to apples" comparisons to support consumer choice, it is necessary to introduce a standard measurement approach. HCAHPS can be viewed as a core set of questions that can be combined with a broader, customized set of hospital-specific items. HCAHPS is meant to complement the data hospitals currently collect to support improvements in internal customer services and quality related activities.

Three broad goals have shaped the HCAHPS survey. First, the survey is designed to produce comparable data on the patient's perspective on care that allows objective and meaningful comparisons between hospitals on domains that are important to consumers. Second, public reporting of the survey results is designed to create incentives for hospitals to improve their quality of care. Third, public reporting will serve to enhance public accountability in health care by increasing the transparency of the quality of hospital care provided in return for the public investment. With these goals in mind, the HCAHPS project has taken substantial steps to assure that the survey will be credible, useful, and practical. This methodology and the information it generates will be made available to the public.

In May 2005, the National Quality Forum (NQF), an organization established to standardize health care quality measurement and reporting, formally endorsed the CAHPS Hospital Survey. The NQF endorsement represents the consensus of many health care providers, consumer groups, professional associations, purchasers, federal agencies, and research and quality organizations.

About the Survey

The CAHPS Hospital Survey can be seen as a core set of questions that may be combined with a broader, customized set of hospital-specific items. The survey is meant to complement to the extent possible, not replace, the data hospitals currently collect to support improvements in internal customer services and quality related activities.

The CAHPS Hospital Survey is composed of 18 patient rating and patient perspectives on care items that encompass seven key topics: communication with doctors, communication with nurses, responsiveness of hospital staff, cleanliness and quietness of hospital environment, pain management, communication about medicines, and discharge information. It also includes four screener questions and five demographic items, some of which may be used for adjusting the mix of patients across hospitals and for analytical purposes. The survey is 27 questions in length.

There are four approved modes of administration for the CAHPS Hospital Survey: 1) Mail Only; 2) Telephone Only; 3) Mixed (mail followed by telephone); and 4) Active Interactive Voice Response (IVR).