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Hospital Quality Initiative – 2006

logo for Center for Medicare and Medicaid ServicesThe Hospital Quality Initiative (HQI) in 2006 is "quasi-mandatory" (or "quasi-voluntary," depending on your perspective), for hospitals. Since its beginnings as a voluntary quality initiative, it has morphed to include developmental components, among which are non-trivial financial incentives. The components include:

  • ◊  Hospital Quality Alliance – a public-private collaboration of the American Hospital Association AHA, Federation of American Hospitals (FAH), the Association of American Medical Colleges (AAMC, the Joint Commission for Accreditation of Healthcare Organizations (JCAHO), and public entities (AHRQ, CMS, et. al.) 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 [see Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU)]. 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 [PDF] 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®. In addition, all hospital performance measures reports for some States are collated and published on the Internet by public agencies (Connecticut, Maryland) or private entities ( Minnesota, Wisconsin).

The NQF has endorsed 42 Hospital care measures. In 2006, the HQI uses only 21 of them as Health Quality Measures

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