Blog » With Reimbursement on the Line, Hospitals Focus on Quality Upgrades

With Reimbursement on the Line, Hospitals Focus on Quality Upgrades

Created Sep 01 2014, 08:00 PM by Lippincott Solutions
  • hospital-acquired conditions
  • ACA
  • AHRQ
  • healthcare-associated infections
  • Affordable Care Act
  • Medicare reimbursement
  • quality care

Tuesday, September 2, 2014
With Reimbursement on the Line, Hospitals Focus on Quality Upgrades

The healthcare industry is in the midst of a massive shift. The days of a volume-based payment model that incentivizes utilization are fading. Replacing them is an outcomes-based payment model that instead incentivizes quality of care and performance.

The change was sparked by the Affordable Care Act—specifically, the Centers for Medicare & Medicaid Services’ subsequent Hospital Readmissions Reduction Program and its Hospital Value-Based Purchasing Program. The former imposes financial penalties to hospitals with Medicare and Medicaid readmission rates that CMS considers too high. The latter provides penalties—as well as bonuses—based on a hospital’s performance on 24 quality measurements.

One Hospitals & Health Networks report estimated that 5-7% of a hospital’s Medicare reimbursement will be on the line in coming years based on its quality, outcomes, and safety performance. To make matters more interesting, private insurers are expected to follow CMS’ lead (when don’t they?) and institute similar pay-for-performance policies of their own.

“Managing the tsunami of reform measures, maintaining the ever-changing standards of care and implementing best practices are key challenges for the industry at large—providers, payers and vendors alike,” the article states.

Thankfully, hospitals don’t have to go it alone. Evidence-based toolkits, protocols, and other resources abound for hospitals upgrading their quality of care. Here are a few good sources. 

Government Groups

The U.S. Department of Health & Human Services’ Agency for Healthcare Research and Quality (AHRQ) offers toolkits, recommendations, protocols, and other information on improving quality care in a number of clinical areas free on its website. Resources available include:

  • A Hospital Guide to Reducing Medicaid Readmissions
  • A Quality Indicators Toolkit for Hospitals
  • A report on Improving the Emergency Department Discharge Process
  • Preventing Falls in Hospitals: A Toolkit for Improving Quality of Care  

CMS’ Partnership for Patients website is also stocked with resources on quality care challenges, including hospital-acquired conditions, healthcare-associated infections, and readmissions. Its Get Involved page provides information on connecting in-person with local quality-focused Hospital Engagement Networks and Quality Improvement Organizations to receive advice on reducing healthcare-acquired conditions, improving care transitions, and reducing hospital readmissions.

By all accounts, Partnership for Patients knows what it’s doing. The group was recently credited with reducing the number of hospital-acquired conditions in U.S. hospitals by 17% between 2010 and 2013, saving an estimated 50,000 lives and $12 billion. If your organization isn’t already involved in the initiative, it’s worth checking into.

Specialty Groups

Some hospitals are making quality gains through programs delivered by specialty organizations, such as the American Association of Critical-Care Nurses. Through participation in the Association’s Clinical Scene Investigator (CSI) Academy, critical care nurses at seven New York hospitals recently developed initiatives that slashed healthcare-associated infections, improved outcomes, and saved an estimated $4.5 million.

“AACN CSI Academy provides frontline nurses with the knowledge and tools for improving the quality and cost of care,” said Diana Mason, PhD, RN, FAAN, president of the American Academy of Nursing. “It teaches nurses how to make the business case for specific approaches to improving patients’ experiences with care, improving clinical outcomes and reducing costs – the ‘Triple Aim’ that is guiding reforms in healthcare today.”

And it generates results. Through their initiative, the New York nurses:

  • Decreased catheter-associated urinary tract infections at three hospitals between 26% and 67%
  • Reduced central line-associated bloodstream infections by 25%
  • Decreased ventilator days up to 33%
  • Reduced tracheostomy breathing tubes by 91%
  • Decreased average length of stay in the intensive care unit by 19%; outside the ICU, 32%

Details on this and other nurse-led quality improvement initiatives are accessible online through the AACN CSI Academy Innovation Database.

Other Sources

Nurses can also keep up on the latest in evidence-based care through attending national, regional, and local conferences, CE training, reading journals, and using point-of-care reference tools.

As AHRQ observes, “Nurses play a vital role in improving the safety and quality of patient care—not only in the hospital or ambulatory treatment facility, but also of community-based care and the care performed by family members. Nurses need [to] know what proven techniques and interventions they can use to enhance patient outcomes.”