The Journal of Healthcare Contracting

Premier Breakthroughs Conference
Quality program yields better patient care

More than 1.1 million patients treated in five clinical areas at hospitals participating in a Centers for Medicare & Medicaid Services (CMS) and Premier Healthcare Alliance pay-for-performance project are living longer and receiving recommended treatments more frequently.

According to results released several days after Premier’s annual Breakthroughs Conference in Nashville, Tenn., more than 250 hospitals participating in the CMS/Premier Hospital Quality Incentive Demonstration (HQID) project raised overall quality by an average of 15.8 percent over three years based on their delivery of 30 nationally standardized and widely accepted care measures to patients in five clinical areas. Improvements in quality of care saved the lives of an estimated 2,500 heart attack patients across the first three years of the project. Patients also received approximately 300,000 recommended evidence-based clinical quality measures, such as smoking cessation, discharge instructions and pneumococcal vaccination, during that same timeframe.

CMS announced that it would award incentive payments of more than $7 million to 112 top-performing hospitals in Year 3, representing the top 20 percent of hospitals in each of the project’s five clinical areas. Overall, 206 awards were given to these top-performing hospitals in the third year of the project. Through the project’s first three years, CMS has awarded more than $24.5 million to top performers.

CMS has extended the project for three additional years. The extension will continue to track hospital performance in the clinical areas of pneumonia, heart bypass, heart attack (acute myocardial infarction), heart failure, and hip and knee replacement. But some new areas will be added, including the Surgical Care Improvement Project (SCIP) and ischemic stroke. The extension will also allow for the testing of new reward models.

Congress has mandated that Medicare develop a plan to implement value-based purchasing, which ties payment to quality of care and other outcomes, beginning with fiscal year 2009. The HQID project is a test of one value-based purchasing model, and served as a guideline for CMS’ recent value-based purchasing proposal to Congress.

Award winners
At the Breakthroughs Conference, Premier recognized three members with its second annual Supply Chain Innovation Award, which recognizes innovations that have created new levels of performance and competitive advantage. Winners were:

Aurora Health Care, Milwaukee, Wis., which won two awards - the first for creating an asset investment recovery program, which has a cradle-to-grave approach to maximize the remaining value of unused or underused medical equipment; and the second for inclusion of a centralized clinical engineering service model in the capital supply chain, thereby creating a fully integrated, cradle-to-grave approach to all assets.
Montefiore Medical Center of New York City, for creating a materials par-stock process using predictive modeling and advanced technology known as materials replenishment processing. By development and use of a template to simplify the ordering process, a bill of material requires users to enter only the quantity required.
Geisinger Health System, Danville, Pa., for developing the use of the global location number (GLN) to structure membership within Premier. This system assigns each healthcare location a unique 13-digit GLN. This registry keeps track of the name, address, class of trade, and organizational hierarchy information about each provider. It also maintains the same information about manufacturers and distributors.

Meanwhile, Premier recognized 18 members as winners of its second annual Supply Chain Excellence Award, which is given to hospitals that have achieved superior supply expense performance as measured by Premier’s SupplyFocus™ comparative database of operational and supply chain cost information for acute-care hospitals. The winners were:

Adventist GlenOaks Hospital, Glendale, Ill.
Akron (Ohio) City Hospital.
Carilion Franklin Memorial Hospital, Rocky Mount, Va.
Carilion Giles Memorial Hospital, Pearisburg, Va.
Carilion Clinic, Roanoke, Va.
Community Health Partners, Lorain, Ohio.
Community United Methodist, Henderson, Ky.
Henry Ford Health System, Detroit.
Henry Ford Hospital, Detroit
Henry Ford Wyandotte Hospital, Wyandotte, Mich.
Marcum & Wallace Memorial Hospital, Irvine, Ky.
Mercy Memorial Hospital, Urbana, Ohio.
Our Lady of the Resurrection Medical Center, Chicago.
Presbyterian Kaseman Hospital, Albuquerque, N.M.
Randolph Hospital, Asheboro, N.C.
Saint Francis Hospital, Evanston, Ill.
Sinai-Grace Hospital, Detroit.
Summa Health System, Akron, Ohio.

Sidebar:
The Question of Standardization

To standardize or no? If yes, on what? And when? How? At what cost? And if successful, how to make it last?

This spring, Premier released the first in a series of guidelines to help its members answer questions regarding standardization of clinical-preference products. The initial module focuses on endomechanical and suture products.

"We believe that there are efficiencies with standardizing anything - be it a product category or clinical process," says Premier Purchasing Partners President Mike Alkire. From a purely financial perspective, standardization can drive market share, which can attract better prices from vendors, which can reduce an IDN’s spending, which can free up capital for other investments, such as equipment, he says.

Premier’s new tool helps contracting executives put the process in perspective. "We really try to understand, first, if there is clinical parity among products," says Alkire. If not, how significant is the difference in outcomes? Perhaps one product can reduce length of stay or lead to reduced usage of antibiotics. Regardless of what it is, "we want to attach some value to that, and we want to make sure it’s proven out with data."

Even though standardization might look like a good option on paper, it might not play out in the real world. And Premier’s tool is designed to help members evaluate that. "Not everybody can always standardize," says Mary Kaye Van Huis, R.N., M.S.N., director, clinical field specialist. "To some degree, it depends on the culture [of the provider], which is why we created the template - so we can share best practices. But not in all cases can you necessarily move the business. So this template allows them to determine how feasible it is to make the move, [and how] comfortable they are making the jump."

In fact, the very first step of any standardization effort - and hence, of Premier’s module - is to identify the opportunity. And that can take six weeks, six months, a year or more. "It’s not a matter of time, it’s a matter of due diligence," says Van Huis. "This is where most members make their mistakes."

By laying out all the potential roadblocks associated with standardization, including resistance from clinicians, the tool may lead the provider to decide against making the move, says Alkire. If that’s the case, so be it, he says. Better to reach that conclusion before subjecting everyone to a painful conversion only to backslide later.