SHM Shapes Pay for Performance
Federal officials are increasingly embracing pay for performance (P4P) in an effort to promote high-quality, cost effective care in government health programs. As the Centers for Medicaid and Medicare Services (CMS) and Congress move forward to implement this concept, SHM is working to ensure that the views of hospitalists are represented in this important debate.
More than 100 P4P programs are already up and running in the private sector in an attempt to reward quality healthcare by setting different payment levels for providers based on how well they meet benchmarks of quality and efficiency. CMS is testing the feasibility of applying this concept to the Medicare program through a number of initiatives.
SHM’s Public Policy and Hospital Quality and Patient Safety committees have been involved in evaluating CMS’ Physician Voluntary Reporting Program (PVRP), launched earlier this year and widely believed to be the precursor to an eventual P4P program for physicians’ services. Under this initiative, physicians are encouraged to submit quality data on a “starter set” of 16 evidence-based measures for certain primary care, surgery, nephrology, and emergency medical services. Physicians who participate in the program receive confidential reports on their performance.
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SHM has recommended that hospitalists register their intent to report and begin reporting on relevant performance measures to the extent practicable as a way of becoming more familiar with the program. Because these initial 16 measures have only limited relevance to services billed by hospitalists, SHM is engaged in discussions with lawmakers and their staffs, CMS officials, and consensus organizations involved in developing quality measures, to expand the program’s scope.
As part of Advocacy Day on May 3, some 70 SHM members met with legislators and their staffs and conveyed SHM’s support for initiatives like the PVRP that seek to measure resource use and improve quality, to attain better value for the Medicare program. (See coverage in The Hospitalist SHM Meeting Reporter, July 2006, p. 1.) Participants also educated lawmakers on the role of hospitalists in helping their institutions meet quality reporting requirements mandated under the Medicare Modernization Act, which ties annual hospital payment updates to the submission of performance data for 10 quality measures. The participants also expressed SHM’s interest in working with CMS on demonstration projects that assess the contributions of hospital medicine programs to improved patient care and more efficient management of hospital resources.
In addition to Congress and CMS, non-governmental groups such as the National Quality Forum (NQF), the American Medical Association Physician Consortium for Performance Improvement (PCPI), and the Ambulatory Care Quality Alliance are actively engaged in providing input to CMS on the PVRP and other P4P-related initiatives. SHM has joined the PCPI, which works with medical specialty organizations to develop physician-level performance measures.
As a new member of the PCPI, SHM submitted feedback during the public comment period on perioperative care measures, the development of which was led by the American College of Surgeons, along with input from other medical specialties. SHM will also participate in two upcoming workgroups—one on emergency medicine, which will focus on treating for MI and pneumonia, and another on geriatrics, which will look at falls, urinary incontinence, and end-of-life care. At least through 2006, the PCPI is focusing on measures that fall under the CMS contract and will be included in the PVRP.
SHM is also a member of the NQF, a nonprofit organization that Congress has charged with endorsing consensus-based national standards for measurement and public reporting of healthcare performance data. NQF is seeking nominations for members of the steering committee and technical advisory panels that will oversee the work on new consensus standards for hospital care. This project, sponsored by the AHRQ, will address issues of patient safety, pediatrics, and inpatient care. SHM will submit nominations during this process and plans to be fully engaged.
