Providers strug­gle on CMS mea­sures

Modern Healthcare - - NEWS - By Me­lanie Evans

Last week, health­care providers got more big doses of the Obama ad­min­is­tra­tion’s prescription for im­prov­ing qual­ity by ty­ing Medi­care pay­ments to per­for­mance. It still isn’t go­ing down easy.

Of the hos­pi­tals that Medi­care will pe­nal­ize in 2016 for hav­ing the worst per­for­mance on mea­sures to pre­vent pa­tient harm, more than half are the list for the sec­ond year in a row.

And for the first time, the CMS pub­lished qual­ity per­for­mance scores for in­di­vid­ual physi­cians, but only for those who vol­un­teered data. Only about 6 in 10 are in­cluded. Ac­cord­ing to the Amer­i­can Med­i­cal As­so­ci­a­tion, which crit­i­cized the agency for post­ing in­com­plete data, that’s be­cause many physi­cians gave up af­ter strug­gling with the sub­mis­sion process and try­ing to cor­rect in­ac­cu­ra­cies.

Un­der a pro­vi­sion of the Af­ford­able Care Act, Medi­care re­duces pay­ments by 1% for the low­est-per­form­ing quar­tile of hos­pi­tals, mean­ing 700 to 800 U.S. hos­pi­tals will get dinged each year. The pro­gram is ex­pected to re­duce Medi­care spend­ing by $364 mil­lion in 2016.

“Our goal is for all hos­pi­tals to im­prove,” and roughly half did im­prove enough to es­cape the bot­tom quar­tile, said Dr. Pa­trick Con­way, the CMS’ deputy ad­min­is­tra­tor and chief med­i­cal of­fi­cer.

Crit­ics of the pro­gram say many hos­pi­tals will have trou­ble climb­ing out of the bot­tom of the heap be­cause the mea­sures’ risk ad­just­ment fails to re­flect that poorer and sicker pa­tients are more likely to have com­plex med­i­cal con­di­tions and ex­pe­ri­ence ad­verse events.

Av­er­age scores im­proved on cen­tral-line-as­so­ci­ated blood­stream in­fec­tions and a com­pos­ite in­dex of eight mea­sures of eight con­di­tions, in­clud­ing pres­sure ul­cers and sep­sis.

Dr. Ashish Jha, a Har­vard Univer­sity health pol­icy pro­fes­sor who has stud­ied the pro­gram, ques­tioned the progress on the com­pos­ite in­dex, which he said might have been the re­sult of bet­ter record­keep­ing by hos­pi­tals. “There is lit­tle rea­son to be­lieve that care has got­ten bet­ter,” Jha said.

The newly posted data on in­di­vid­ual doc­tors score their per­for­mance on rou­tine screen­ings and pre­ven­tive care for com­mon chronic con­di­tions such as heart dis­ease and diabetes.

Doc­tors who fail to re­port the 2014 data face a Medi­care penalty in 2016.

“We heard from con­sumers that they wanted both group in­for­ma­tion and in­di­vid­ual physi­cian in­for­ma­tion,” Con­way said. “We need to con­tinue to push to ac­cel­er­ate the pace of change and im­prove­ment.”

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