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H H S Department of Health and Human Services
U.S. Department of Health and Human Services
Health Information Technology and Quality
Improvement

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What are the other major Federal QI Initiatives?

CMS/Premier Hospital Quality Incentive Demonstration (HQID)

The Premier Hospital Quality Incentive Demonstration (HQID), a Centers for Medicare and Medicaid Services (CMS) pay for performance program through Premier, is designed to determine if financial incentives to improve hospitals’ quality of inpatient care are effective. It is the first program of its kind.  HQID was launched in 2003 as a 3 year program and has subsequently been extended by CMS for an additional 3 years.

HQID aims to explore ways to reward top-performing hospitals and creates financial incentives to improve care.  Participating hospitals receive additional Medicare payments and recognition if they score well on the process and outcomes measures.  Health IT and EHR use serves as a way for hospitals to increase quality, thus receiving incentive payments.

Through the program, Premier collects more than 30 clinical quality measures from more than 250 hospitals nationwide. Participating hospitals range in size from small to large, are both urban and rural, and include teaching and non-teaching facilities.  Safety net providers are also represented in the HQID sample.  Process and outcome measures are tracked across five clinical areas (1) acute myocardial infarction (AMI), (2) heart failure, (3) coronary artery bypass graft (CABG), (4) pneumonia and (5) hip and knee replacement.

Data from the first 3 years show sustained improvements in quality of care at participating hospitals, with HQID hospitals improving their  Composite Quality Score (an aggregate score of all quality measures in each area) by an average of 4.4 percent between the second and third year of the program.  Additionally, patients treated at participating hospitals were shown to receive more services, such as smoking cessation programs and discharge instructions during the first three years of the program.  Another important finding shows that safety net hospitals, which serve a disproportionate amount of uninsured and underinsured patients, who participated in HQID demonstrated similar performance as other hospitals on quality measures related to heart attack, heart failure and joint replacement after three years.

Related Resources:

Hospital Quality Incentive Demonstration  go to exit disclaimer- Premier
Premier Inc. go to exit disclaimer

Centers for Medicare & Medicaid Services

Quality Improvement Organizations (QIOs)

CMS contracts with Quality Improvement Organizations (QIO) (formerly known as Peer Review Organizations or PROs) in each state to monitor and improve the quality of care for people on Medicare. QIOs are private, mostly not-for-profit organizations and are represented by the American Health Quality Association.  QIO contracts are for 3 years in length.  Additionally, QIOs stress the importance of utilizing health IT, in particular EHRs, as a valuable tool to improve quality.  QIOs assist care providers in the adoption, implementation, and usage of EHRs.

To help health care providers achieve quality improvement, QIOs employ doctors and other health care experts who are available to assist health care providers in monitoring and improving the quality of care given to Medicare patients. QIOs review patients’ complaints about quality of care provided by:

  • Hospitals
  • Skilled nursing facilities
  • Home health agencies
  • Medicare managed care plans
  • Ambulatory surgical centers

In addition, CMS sponsors The Medicare Quality Improvement Community (MedQIC), a national knowledge forum for healthcare and quality improvement professionals. MedQIC supports QIOs and providers of services to Medicare beneficiaries in finding, using, and sharing quality improvement resources. The information found on MedQIC includes provider and QIO interventions that can change processes, structures, or behaviors in health care settings. In addition, various tools, literature, and success stories are available for MedQIC users to study and implement in their own quality improvement efforts. MedQIC contains clinical materials for each of the quality measures.

Related Resources:

Quality Improvement Organizations Overview - Centers for Medicare & Medicaid Services
Medicare Quality Improvement Community  go to exit disclaimer- QualityNet

The Physician Quality Reporting Initiative (PQRI)

The Physician Quality Reporting Initiative (PQRI) is a pay for performance reporting program, offering financial incentives for participation that is open to all health care providers who treat Medicare patients.  Health care providers participate in PQRI by reporting quality measures and information to CMS about specific services provided frequently to their Medicare patients with certain medical conditions. This information helps providers to measure the quality of care provided to Medicare beneficiaries.

The 2009 PQRI consists of 153 quality measures and 7 measures groups, which are relevant to generalists and specialists alike and serve as a good way to assess clinical performance.  Participants do not need to enroll but simply need to report the appropriate quality codes on service lines of Part B Physician Fee Schedule professional –service claims. Participants can use EHRs, registries and other external reporting tools to submit their reports to CMS.  Recently, PQRI has created a reporting tool called PQRI Wizard go to exit disclaimer, that enables participants to send their data to CMS easily, and cost efficiently.

Because Medicare is the largest payer for health services in the United States, utilizing such a reporting program enables CMS to have the potential to use payment policies to improve health care quality.  CMS has also provided flexibility in PQRI reporting for providers who serve Medicare, Medicaid and SCHIP patients, thus encouraging these providers to participate.

Related Resource:

PQRI Overview - Centers for Medicare & Medicaid Services

The Medicare and Medicaid EHR Incentive Programs

The Medicare and Medicaid EHR Incentive Programs provide incentive payments to eligible professionals and eligible hospitals to adopt, implement, upgrade or demonstrate meaningful use of certified EHR technology.  

To demonstrate meaningful use of EHRs, the EHR Incentive Programs requires that providers fulfill a number of objectives and measures that target one of five health outcome priorities.  The functional objectives and measures include 15 “core” (mandatory) criteria and 10 other “menu” criteria, from which providers must select to report on five.  To meet and report these objectives and measures, providers must use EHR technologies that meet the certification standards set by the Office of the National Coordinator for Health IT (ONC).

The EHR Incentive Programs also include requirements for clinical quality reporting.  There are three “core” clinical quality measures that must be reported, three “alternate core” clinical quality measures that may be reported if the “core” measures are not applicable to the provider’s practice, and 38 “additional” clinical quality measures which may be reported if the core and/or alternate measures are not applicable.  For a full list, see CMS’ Overview of Clinical Quality Measures.

Related Resources:

Medicare and Medicaid EHR Incentive Programs - Centers for Medicare & Medicaid Services
Overview of Clinical Quality Measures - Centers for Medicare & Medicaid Services

Electronic Prescribing (eRx) Incentive Program

The Medicare Electronic Prescribing Incentive Program (eRx), which began January 1, 2009 and is authorized under the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), provides incentives for eligible professionals who are successful electronic prescribers.

Providers who participate in the 2010 eRx Incentive program, individual EPs may choose to report on their adoption and use of a qualified eRx system by submitting information on one eRx measure: (1) to CMS on their Medicare part B claims, (2) to a qualified registry, or (3) to CMS via a qualified electronic health record (EHR) product.  To be considered a successful electronic prescriber for the 2010 eRx Incentive Program and potentially qualify to earn a 2.0% incentive payment for the 2010 eRx Incentive Program, an individual EP must report the eRx measure for at least 25 unique electronic prescribing events in which the measure is reportable by the EP during 2010.

A group practice may also potentially qualify to earn an eRx incentive payment equal to 2% of the group practice's total estimated Medicare Part B Physician Fee Schedule (PFS) allowed charges for covered professional services furnished during the 2010 eRx reporting year based on the group practice meeting the criteria for successful electronic prescriber specified by CMS.

Related Resource:

Electronic Prescribing Incentive Program – Centers for Medicare & Medicaid Services

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