For this hospital, money is secondary
Memorial Health System in Springfield, IL, one of the participants in the CMS (Centers for Medicare & Medicaid Services)/ Premier Hospital Quality Incentive (HQI) Demonstration Project, certainly will not be disappointed when it receives the financial incentives it stands to earn through improved quality.
However, says James R. Bente, RN, MBD, vice president of quality and organizational development, that was not the prime consideration for participating in the project.
"When I became aware this was under way, I took it to our entities and said, I think we want be part of it’ — not so much for reimbursement, though that was well received, but for transparency and to be in a cohort of other organizations that are also striving to be better than they are today," he says. "When CMS launched the program, we probably sent our confirmation the same day they announced it, making us the first in the nation to get involved."
For Bente, this was the next logical step in a long journey for the system, a multifacility organization with three hospitals — a flagship 550-plus bed tertiary receiving facility (Memorial Medical Center) and two critical access hospitals — and four other health care service entities.
"As a health system, we’ve made a commitment toward performance excellence and safety and translated that into very meaningful perspectives, such as a performance excellence model," he explains. "Quality means reduced variation, safety, preventing harm, and clinical effectiveness — providing evidence-based care. When we looked at the demonstration project, we also set as a goal for ourselves to be a Baldrige-level performer by the end of the decade."
But for his five years at Memorial, Bente says he is most proud of the system’s transparency to itself and to its patients. "As things have evolved with looking at different indicators, there has been a tremendous convergence — CMS, JCAHO [the Joint Commission on Accreditation of Healthcare Organizations], and so on — around some very similar diseases as they collaborated and agreed they were interested in many of the same things," he notes. "This really got me excited. Out of that came Voluntary Hospital Reporting by AHA [the American Hospital Association], and now the Hospital Quality Alliance."
As a result, Memorial became one of the first systems to agree to public reporting of such measures as acute myocardial infarction (AMI), heart failure, and pneumonia. "Otherwise, we would not have been transparent," Bente notes.
| Pay-for-performance programs continue to proliferate
According to a new national study, the number of pay-for-performance (P4P) programs nationwide has increased sharply since 2003. In its 2003 study, Med-Vantage, a health care informatics company in San Francisco, identified 35 P4P programs and predicted that number would double by 2006. Med-Vantage’s new study, released last month, indicates that by November 2004, the number of P4P programs had risen to 84, covering 39 million beneficiaries, and by March 2005, the number had increased to 104. According to the report, ’Based on continuing health plan and employer interest, as well as emerging new sponsors, Med-Vantage predicts that the number of P4P program sponsors will almost double again from 84 [2004] to 160 by 2006.” According to the study, current trends in P4P include ’the emergence of the Centers for Medicare & Medicaid Services as a P4P market driver” and ’growing interest in using P4P performance results for public reporting to consumers.” The executive summary of the report is available at www.medvantageinc.com. |
Pride a big motivator
Bente says that Memorial did not really adjust its approach to quality as a result of the project.
"We were already working very diligently on a lot of these things," he explains. "But our doctors are data-driven and outcomes-focused; we showed them that we had data from other hospitals that were among the better performers. By showing them we were part of this elite group . . . we could compare ourselves to the best. That stirs a sense of pride."
And Memorial did, in fact, see significant improvement. "There were a couple of areas that really stood out more than any others," Bente says. "Our performance in door to antibiotics for pneumonia, for example, rose from 70% to in excess of 85%; that was huge. Another big area was the starting of preoperative prophylactic antibiotics. We saw improvements in all surgery areas from the 60s and 70s to virtually 100%."
Does Bente think the P4P factor had an impact on hospital performance? "To me, it could be an outgrowth [of the incentives], which is a nice thing to have at the end of the day, but if you focus on that as a driving factor, it will be a mistake," he asserts. "To make these changes, it really does take two major things: Have the goal you want to achieve — and you must be focused around the patient. Plus, you have to have the right culture in place."
Model is attractive
Bente is, however, a supporter of the model used by CMS. "I do like this model, and here’s why: It’s very simple and very straightforward," he says. "Anyone can understand it — there are no hidden black boxes.’ I know that The Leapfrog Group has done one, and it is weighted differently for different indicators — which I can see intellectually. Should they be weighted differently? That’s a great question."
The answer for now, he says, is probably not. "You start to introduce some degree of cynicism in the process, and people ask who decided these weights — and once somebody has any question about methodology, you diminish the ability to use a tool effectively with a broad range of audiences," Bente explains.
"This way, it is a simple denominator/numerator thing. When you look at all the indicators, you just add all the numerators and denominators and divide for the score. It is this straightforwardness and comparativeness that gives the demonstration project its strength," he adds.
Need More Information?
For more information, contact:
- James R. Bente, RN, MBD, Vice President, Quality and Organizational Development, Memorial Health System, Springfield, IL Phone: (217) 788-3691. E-mail: [email protected].
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