Aurora hospitals stand out
19.06.2008 04:00
Health
- Source: JS Online
More than four years ago, Aurora Health Care signed up for a project based on a radical concept. Medicare would pay hospitals bonuses tied to the quality of patient care, and how the hospitals performed would be publicly disclosed. Aurora's hospitals overall started in the middle of the pack. Now four of them are standouts, and all of them are strong performers. Those results are based on the third year of the demonstration project by the Centers for Medicare & Medicaid Services and Premier Inc., an alliance of nonprofit hospitals. The project was the first to link what Medicare pays hospitals to the quality of care they provide. About 250 hospitals nationwide can receive higher payments if their performance is in the top 20% for five high-volume, inpatient conditions. The conditions are heart attack, bypass surgery, heart failure, pneumonia, and hip and knee replacement. The 10 Aurora hospitals in the project were eligible for a total of 42 bonus payments. They received 24. "Generally, across the board, we did very, very well on this," said Patrick Falvey, senior vice president and chief integration officer, who oversees quality improvement for Aurora. No health care system in the country did better overall. The performance means that Aurora will receive nearly $376,000 in higher payments from Medicare. The standout in Aurora's system was its hospital in Sheboygan, which ranked in the top 20% in the care it provided for all four of the medical conditions measured. The hospital doesn't do bypass surgery. In the Milwaukee area, West Allis Memorial and Aurora Sinai Medical Center ranked in the top 20% for two of the five medical conditions. The demonstration project - the Premier Hospital Quality Incentive Demonstration - was designed to test what is called pay-for-performance. The idea is to reward doctors and hospitals for the quality - and, someday, the efficiency - of the care they provide. Under the existing system, they are paid based on how much they do, even if the care is poor quality or unneeded. The results from the demonstration project laid the groundwork for Medicare to propose that a percentage of payments to hospitals be tied to their performance on specific quality measures. The proposal - called "valued-based purchasing" - was given to Congress late last year. "The lessons here have been enormously helpful," said Mark Wynn, who oversees pay-for-performance demonstration programs for Medicare. Hospitals improve overallThe hospitals in the demonstration project were ranked based on how well they adhered to recommended guidelines for treating patients. An example is whether a patient was given an antibiotic one hour before surgery to replace a hip or knee and whether the antibiotics were stopped within 24 hours after surgery.The 250 hospitals in the demonstration program have shown significant improvement since the project began. But so, too, have most hospitals in recent years. A study published in the Journal of the American Medical Association last year found that there was no statistical difference between the gains shown by other hospitals and those in the demonstration project. The study said hospitals in the project showed more improvement overall. Being ranked in the top 20% also got considerably harder each year that the study went on. "What you see in this project, everyone was getting very good," Falvey said.
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