The 2006 American Hospital Association involvement in performance measurment is limited to the Health Quality Alliance, an evolving national partnership that began with the AHA, the Federation of American Hospitals (FAH), and the Association of American Medical Colleges (AAMC). Utilizing JCAHO's four initial core measurement areas for hospitals that were released in May 2001, the National Voluntary Hospital Reporting Initiative began in 2002 as an entirely voluntary initiative with support of CMS, AHRQ, JCAHO, and the AMA and multiple other stakeholders. In 2003, this hospital effort was incorporated into CMS Health Quality Initiative, (which also includes nursing homes and home health care), thereby creating the Hospital Quality Alliance.
Hospital Quality Alliance Initiative – 2006
The Hospital Quality Alliance Initiative – sometimes referenced as HQI – in 2006 is "quasi-mandatory" (or "quasi-voluntary," depending on your perspective), as it has morphed into a collection of developmental components that include financial incentives.1 The components include:
- ◊ Hospital Quality Alliance – the public-private collaboration that collects and reports hospital quality performance measures to CMS as part of a national public initiative
- ◊ MMA of 2003, Section 501b – The Medicare Prescription Drug and Modernization Act of 2003 stipulates that a Perspective Payment System (PPS) hospital that does not submit performance data for 10 quality measures will receive a 0.4% lower update for Fiscal Years 2005, 2006, and 2007 than a hospital that does submit performance data.
- ◊ The Deficit Reduction Act of 2005 (DRA) – federal law that stipulates that a PPS hospital that does not submit data for the designated quality measures will receive a 2% lower update than a hospital that does submit performance data. The DRA supercedes the Annual Payment Update (APU) for Fiscal Year 2007 and continues through Fiscal Year 2008 and each subsequent fiscal year,
- ◊ HCAHPS – the hospital patient survey addressing patient satisfaction with care, which through 2006 has undergone testing in 1) a 3-State CMS Hospital Pilot project in Arizona, Maryland, and New York, 2) a special partnership with the Connecticut Department of Public Health, where the Connecticut legislature has mandated that public reporting of hospital data be aligned with CMS national voluntary reporting initiatives by April 2004, and 3) the CMS-Premier Hospital Quality Incentive Demonstration that provides financial rewards to top performing not-for-profit hospitals in a number of areas of acute care. HCAHPS reporting in the HQI begins in 2007.
Through 2005, the Hospital Quality Measures of the HQA included only 20 performance measures. [The ‘Influenza Vaccine’ measure was excluded in 2005 because of scattered national vaccine shortages.] With restoration of vaccine reserves, the influenza vaccine measure is included in the 2006 iteration of 21 Health Quality Measures [PDF]. The HCAHPS measure will be added in 2007.
- • Acute myocardial infarction (AMI) – 8 measures
- • Heart failure (HF) – 4 measures
- • Pneumonia (PN) – 7 measures
- • Surgical infection prevention (SIP) – 2 measures
- • HCAHPS – 1 measure (2007)
Facility-identified performance for these common measures are published by CMS at Hospital Compare®.
1 ‘HQI’ is the abbreviation used by the CMS/Premier Hospital Quality Incentive Demonstration, which is a pay-for-performance (P4P) initiative. HQI is also often used to abbreviate the much larger Hospital Quality Initiative, which evolved from the Hospital Quality Alliance and which in 2006 has no report card P4P features. To avoid potential ambiguity, one should use HQA when referencing the Hospital Quality Alliance Initiative.