Magazine article Drug Topics

CMS Pay-for-Performance Pilot Engages R.Ph.S

Magazine article Drug Topics

CMS Pay-for-Performance Pilot Engages R.Ph.S

Article excerpt

The clinical success of an ongoing pay-for-performance (P4P) pilot project by the Centers for Medicare & Medicaid Services requires extensive participation by health-system pharmacists. "Our input meant participation in creating protocols of quality care," said Marie-Elsie Ade, Pharm.D., director of pharmacy, at Homestead Hospital in Homestead, Fla. The hospital recently received a financial incentive payment from CMS as part of the project. "We were involved from the first creation of the team."

Ade is referring to her facility's multidisciplinary team of doctors, nurses, quality improvement staff, and pharmacists. They created treatment protocols for participation in the P4P initiative. "The original hypothesis was to discover whether financial incentives could improve the quality of care," said Leigh Ann Myers, R.N., national director of clinical service for Premier Inc., a San Diego-based nationwide alliance of about 1,700 not-for-profit hospitals, which is participating in the ongoing pilot. "But we discovered much more."

Launched in October 2003, the CMS/Premier Hospital Quality Incentive Demonstration (HQID) project involves more than 260 hospitals, which submit data to Premier for validation and analysis. Premier then submits the data to CMS. The P4P pilot, the first of its kind by the federal government, requires hospitals to report process and outcome measures in five clinical areasacute myocardial infarction (AMI), congestive heart failure, coronary artery bypass graft, pneumonia, and hip and knee replacement.

"We found that financial incentives are effective, but that our hospitals went beyond what a financial incentive led them to do," said Myers. "In fact, the money did not necessarily justify participation for many of the hospitals because of the cost. But they were motivated by a belief that collaboration and communication would improve quality. The best sign of that is they all quickly shared what they learned with one another even though they were competing."

The P4P model used in the project includes financial incentives for the top 20% of hospitals in each of the five clinical areas. The top 10% of hospitals receive a 2% incentive payment for patients in that clinical area, based on each hospital's existing Medicare reimbursement in each clinical area. Those hospitals in the second decile receive a 1% incentive payment. …

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