With the arrival of value-based purchasing (VBP), many hospitals have faced hard decisions about where to allocate scarce resources to maximize their performance potential. In some cases, those decisions have been made even more difficult by a set of core measures still very much in flux. For hospitalists, that means the ability to quickly adapt and reprioritize will be in high demand as measures are added or subtracted from the value-based purchasing program.
In the proposed program rules released in mid-January, CMS initially selected 17 core clinical measures from a list of 28 eligible candidates included in the Hospital Inpatient Quality Reporting (IQR) Program (https://www.cms.gov/HospitalQualityInits/08_HospitalRHQDAPU.asp) and also listed on the public Hospital Compare website (www.hospitalcompare.hhs.gov/) for at least one year. CMS explained its decision to withhold some of the remaining core measures from the program by noting that they were “topped out” and thus provided a poor basis of comparison among hospitals. Others, according to the agency, were of little value or were encouraging bad behavior.
CMS used the latter reason in its explanation for why it was not including an eligible core measure on administering antibiotics to pneumonia patients within six hours of their arrival at a hospital. “We do not believe that this measure is appropriate for inclusion because it could lead to inappropriate antibiotic use,” the rules stated. For that measure and others not recommended for inclusion in the hospital VBP program, CMS added that it would propose retiring them “in the near future.”
—Laura M. Dietzel, program director for High-Tech Meaningful Use, PeaceHealth
Laura M. Dietzel, program director for High-Tech Meaningful Use at PeaceHealth, a faith-based healthcare system that operates eight hospitals in three Western states, says CMS’ short statement caught her health system off-guard and forced a rapid shift in its priorities. “We were really focusing on moving some numbers and making some technology changes for some core measures that now, based on what CMS has in the proposed value-based purchasing, will not be around even as of next year,” she says.
Dietzel says the move to high-tech tools like electronic medical records (EMRs) has further complicated how hospitals and healthcare systems like PeaceHealth are preparing for the VBP program. For two other measures that relate to pneumonia immunization, she says, some of PeaceHealth’s hospitals have “less than ideal” scores that could potentially create some financial risk.
An EMR system on tap for next year, she says, likely will help the hospitals significantly improve their scores. But what should they do between now and then: Reinvent the wheel to prop up their numbers, only to do it again in a year? Or should they take a temporary hit until the more comprehensive system is in place?
Similar questions are likely to confront more healthcare providers as the program expands and evolves. Even as it will likely retire some measures in fiscal year 2014, CMS will add more from a list of 20 related to hospital-acquired conditions and complications, patient safety indicators, inpatient quality indicators, and mortality rates.