Components of the Hospital Quality Initiative

The Hospital Quality Initiative (HQI), like other CMS quality initiatives, consists of many facets. Its goals are to improve the care provided by the nation’s hospitals and to provide quality information to consumers and others. CMS has several efforts in progress to provide hospital quality information to consumers and others and improve the care provided by the nation’s hospitals.

RHQDAPU
The Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU) initiative is intended to equip consumers with quality of care information to make more informed decisions about their health care, while encouraging hospitals and clinicians to improve the quality of inpatient care provided to all patients. The hospital quality of care information gathered through the initiative is available to consumers on the Hospital Compare Web site.

HCAHPS
CMS, along with its sister agency AHRQ, has developed a standardized survey of patient perspectives of their hospital care, known as Hospital CAHPS (HCAHPS). Information from this survey was first publicly reported on Hospital Compare in March 2008. Public reporting of patients’ perspectives of the quality of hospital care will encourage consumers and their physicians to discuss and make more informed decisions on how to get the best hospital care, as well as increase the public accountability of hospitals.

Rewarding Superior Performance
CMS is exploring pay-for-performance via the Premier Hospital Quality Incentive Demonstration. Under the demonstration, hospitals will receive bonuses based on their performance on quality measures selected for inpatients with specific clinical conditions: heart attack, heart failure, pneumonia, coronary artery bypass graft, and hip and knee replacements. CMS will categorize the distribution of hospital scores into deciles to identify top performers for each condition. For each condition, all of the hospitals in the top 50 percent will be reported as top performers. Those hospitals in the top 20 percent will be recognized and given a financial bonus. By the end of the demonstration, it is anticipated that participating hospitals will show improvement from performance in year one. In year three, hospitals will receive lower payments if they score below clinical baselines set in the first year for the bottom 20 percent of hospitals.