Mortality, costs still declining in HQID demo

Premier: Hospital costs could decrease $4.5 billion

Mortality rates and hospital costs at facilities participating in the Centers for Medicare and Medicaid Services (CMS) pay-for-performance demonstration project continue to decline, according to analysis by the Premier health care alliance.

Premier claims that, based on data from participating Hospital Quality Incentive Demonstration (HQID) hospitals, if all hospitals nationally were to achieve the three-year cost and mortality improvements found among the HQID project participants for pneumonia, heart bypass, heart failure, heart attack (acute myocardial infarction), and hip and knee replacement patient populations, they could save an estimated 70,000 lives per year and reduce hospital costs by more than $4.5 billion annually.

Premier collected a set of more than 30 evidence-based clinical quality measures from more than 250 hospitals across the country.

The analysis reviewed 1.1 million patient records, which represents 8.5% of all patients nationally within those clinical areas over the three-year timeline. For hospitals participating in the HQID project, the median Composite Quality Score (CQS), a combination of clinical quality measures and outcome measures, improved by an average of 17.3% across all clinical areas between the inception of the program in October 2003 and the end of June 2007

On the average, the median hospital cost per patient for participants in the project declined by more than $1,000 across the first three years, whereas the median mortality rate decreased by 1.87%. The median Appropriate Care Score (ACS), also referred to as "perfect process score," to designate when a patient receives all possible care measures within a clinical area, improved by an average of 52.6% across all clinical areas.

When Premier compared these data to those of non-participating hospitals, the quality score of hospitals in the HQID project on 19 publicly reported quality indicators was 6.5% higher.

Broad analysis

This analysis is "the broadest of its kind," according to Premier. "There are 1.1 million discharges associated with the data, and also very detailed clinical benchmarks — as well as all the related process benchmarks," explains Richard Norling, president and CEO of Premier. "As a result our database has fully loaded costs."

Norling goes on to say that the rate of quality improvement in the project has "improved," if you will, over the three years. "The first analysis we did was year one, and if you look at overall improvement, year No. 1 was when we had the most variability in performance," he says. "As we went from year to year, all the hospitals got closer and the good ones got better."

Now, he continues, the project has a multi-year trend on the reduction of mortality and costs and constant dollars. "So we see a strong association at the patient level between executing processes being incented and lower mortality and costs. Year three corroborates year one as regards to those associations — the relationship between reliably executing evidence-based processes and a reduction in mortality and cost."

This only makes sense, says Norling. "Obviously, in year 'one' we had a lot of hospitals just getting into the program and ramping up," he notes. "By year three we saw an aggregate improvement pattern."

In addition, he says, there are many more hospital-specific analyses being conducted. "One hospital reduced heart attack mortality by almost 50%," he points out. "We can trend the results as time goes on, but there are a lot more very specific examples of hospitals that had incredible results in their communities."

The demonstration project was initially slated to last three years, but because of its success, notes Norling, CMS decided to extend it for an additional three years. "We are in year five and continue to have good results and examples," he notes.

Lessons learned

Norling says valuable lessons have been learned about what sets the high-performing hospitals apart. "I think probably the most important thing is that high-performing hospitals make quality a top priority; that includes the board, its relationship with the medical staff, the expectations of the CEO and the quality team," he says.

Reliability is another critical factor, Norling adds. "The results we are talking about make it clear that you have to reliably execute each and every evidence-based process," he says. "It underscores the importance of reliable execution."

In addition, he says, rather than just looking at their own data and internal capabilities, hospitals have had the chance to collaborate with other facilities and to learn from their successes — as well as their failures. "The collaborative approach is really significant," he asserts.

"We also learned that many of the improvements made were not necessarily complicated, but it takes tenacity to ensure they are being done each and every time for every patient," he concludes.

[For more information, contact:

Alven M. Weil, MBA, Communications/Public Relations Manager, Premier Inc., 2320 Cascade Pointe Blvd., Charlotte, NC 28208. Phone: (704) 733-5797.]