Crozer-Keystone Health System and Independence Blue Cross (IBC) are jointly developing a model hospital pay-for-performance program. Crozer-Keystone will serve as a beta test site for this new program, which began on Aug. 1. The program will reward the health system for following best practices for identified conditions and meeting agreed-upon quality standards.
“We are working very closely with IBC to establish pay-for-performance measurements that are fair and have results that are valid and easily measured,” says Eileen Young, Crozer-Keystone Health System’s assistant vice president of Quality Utilization and Outcomes. “The identified measures are heavily based on the existing Evidence Based Medicine (EBM) projects, and will help us keep our focus on this initiative and on providing the best care to our patients.”
According to Young, pay-for-performance is a new trend in health care and will certainly be new for Crozer-Keystone and Independence Blue Cross. IBC is working to develop a program that can be applied across its network of hospitals.
“At the present time, the program contains a core set of measures focused on the Hospital Quality Alliance Measures, Pennsylvania Healthcare Cost Containment Council mortality and readmissions data, AHRQ Patient Safety Indicators and length of stay,” Young says. “The remainder of the program will be elective measures that the hospital can pick for program inclusion. This allows the hospital to be recognized for performance improvement projects important to them that may not be adopted at another hospital. For example, our VHA collaborative project to improve the care of our ventilated ICU patients will be one of our elective measures.”
As a beta site, the selected measures, weighting and scoring will be part of the dynamic process, closely evaluated to ensure that they are both reasonable and attainable. Both parties are interested in learning whether pay-for-performance can impact care delivery in the name of improving quality.
“The health care industry has turned to pay-for-performance programs to encourage members to use lower-cost and better quality hospitals, provide hospital quality information to consumers so they can make more informed choices, and reward hospitals that are high performers,” Young says.
Insurance companies are not the first to participate in pay-for-performance programs with hospitals. Medicare has recently announced that according to preliminary reports, quality of care has improved significantly in the 270 hospitals participating in its pay-for-performance demonstration project. The preliminary analysis shows improvement in all five clinical areas being tracked in the three-year demonstration.
Under the Medicaid demonstration project, a hospital can receive bonuses in its Medicare payments based on how well it meets the quality measures. Hospitals are scored on measures for each condition, and those in the top 10 percent for a given condition will receive a two percent bonus on their Medicare payments for that condition. Hospitals in the second 10 percent will be given a one percent bonus. Hospitals in the remainder of the top 50 percent get recognition for their quality, but no bonus.
Dale Schumacher, M.D., Crozer-Keystone Health System clinical informatics officer, notes that insurance companies have also been piloting pay-for-performance programs with physicians for over two years. “They began with disease-specific pay-for-performance, usually diabetes, and have expanded to a statewide program in California and recently to tier programs (in St. Louis, United Health Care excludes the highest cost ‘tier’ of physicians on its General Motors plan),” he says. “Medicare also began a physician pay-for-performance demonstration project in April 2005 with 10 physician groups and anticipates expanding the program.”
CKHS is also participating in a pay-for-performance program with Independence Blue Cross. The goal of the program is to align payment incentives with the practice of high quality, safe health care for all patients.
For more information on the Crozer-Keystone pay-for-performance program, contact Young at (610) 328-8246, 16-8246.