EDITOR’S NOTE: This month, we introduce a new column, “On the Horizon: Quality, Systems, Safety.” Herein, author Win Whitcomb, MD, MHM, one of SHM’s founders and medical director of healthcare quality at Baystate Medical Center in Springfield, Mass., will deliver his views on all things quality and monitor the major issues affecting hospitalists today. As a companion to Dr. Whitcomb’s perspectives, you’ll find “The View from the Center.” “The View” will on occasion provide readers with news and details of how SHM’s Center for Hospital Innovation and Improvement (“the center”) is addressing implementation of healthcare reform, planning programs to improve quality and safety of care, and influencing decisions that will affect hospital medicine for years to come.
Burke Kealey, MD, SFHM, SHM board member and medical director with HealthPartners in Minneapolis, once remarked, “The core measures program is one of the greatest gifts hospital medicine has been given.” Scoring high on the Centers for Medicare & Medicaid Services (CMS) core measures has been a no-brainer for many hospitalist programs over the years; this success has allowed hospitalists to distinguish themselves from traditional PCPs in the hospital.
Looking back, many of us saw the huge opportunity created by the core measures a decade ago. What could be so hard about writing for a flu shot or ordering an echocardiogram? We joined teams, and put systems in place to ensure high performance and, ahem, figured out how to jump through documentation hoops. (Who disputes that quality improvement is two parts better care, one part managing the medical record?)
The result? A bonanza for hospitalists (as overachievers) in the process measures known as the CMS core measures. Admittedly, some of us have struggled more than others in achieving high performance on some of the measures. For example, we couldn’t for the life of us figure out how to excel in “discharge instructions” for heart failure patients at my hospital because we stunk at medication reconciliation. And, being the team sport that QI is, some of these struggles have been beyond hospitalists’ influence.
Well, times are changing, and a good number of core measures (the CMS Inpatient Quality Reporting, or IQR, Program) recently have been retired or suspended. Table 1 outlines the retired or suspended CMS measures; The Joint Commission is retiring many, but not all, of the same measures. To clarify, CMS uses Hospital IQR measures for reporting on the public website hospitalcompare.hhs.gov and, beginning in 2013, a subset will make up part of the value-based purchasing program (see “Value-Based Purchasing Raises the Stakes,” May 2011, p. 1, or visit www.hospitalmedicine.org/vbp). For the commission, the measures are used as part of the survey process for hospital accreditation.
The changes described in Table 1 denote measures that will be retired or suspended from the FY14 Hospital IQR measure set, and were reflected in hospital discharges effective Jan. 1, 2012. In other words, the changes are reflected in CMS’ collection of data from hospitals as of this year.
A few words of explanation of the table terms: “AMI,” of course, stands for acute myocardial infarction, “HF” is heart failure, and “PN” is pneumonia.
“Retire” means just that. Let’s hope so, and not what Michael Jordan meant when calling it quits the first time to try out baseball.
“Suspended” means CMS is retaining the measure in the IQR program but is not collecting data until such time that evidence shows hospital performance has unacceptably declined. Win’s word: Hard to know exactly what that means. It scares me enough that my hospital will continue data collection for internal purposes and not take our eye off the ball regarding performance.