centers for medicare & medicaid services and quality-based purchasing kenneth s. fink, md, mga,...
TRANSCRIPT
![Page 1: Centers for Medicare & Medicaid Services and Quality-Based Purchasing Kenneth S. Fink, MD, MGA, MPH Chief Medical Officer CMS Region X](https://reader035.vdocument.in/reader035/viewer/2022062321/56649db05503460f94a9e09d/html5/thumbnails/1.jpg)
Centers for Medicare & Medicaid Centers for Medicare & Medicaid Services and Services and
Quality-Based PurchasingQuality-Based Purchasing
Kenneth S. Fink, MD, MGA, MPH
Chief Medical OfficerCMS Region X
![Page 2: Centers for Medicare & Medicaid Services and Quality-Based Purchasing Kenneth S. Fink, MD, MGA, MPH Chief Medical Officer CMS Region X](https://reader035.vdocument.in/reader035/viewer/2022062321/56649db05503460f94a9e09d/html5/thumbnails/2.jpg)
IOM DefinitionsIOM Definitions
• Quality“The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge”
• Efficiency“In an efficient health care system, resources are used to get the best value for the money spent. The opposite of efficiency is waste, the use of resources without benefit to the patients….”
![Page 3: Centers for Medicare & Medicaid Services and Quality-Based Purchasing Kenneth S. Fink, MD, MGA, MPH Chief Medical Officer CMS Region X](https://reader035.vdocument.in/reader035/viewer/2022062321/56649db05503460f94a9e09d/html5/thumbnails/3.jpg)
IOM RecommendationIOM Recommendation
That … the Department of Health and Human Services create an environment that fosters and rewards improvement by:• creating an infrastructure to support
evidence-based practice, • facilitating the use of information
technology, • aligning payment incentives, and • preparing the workforce to better serve
patients in a world of expanding knowledge and rapid change.
![Page 4: Centers for Medicare & Medicaid Services and Quality-Based Purchasing Kenneth S. Fink, MD, MGA, MPH Chief Medical Officer CMS Region X](https://reader035.vdocument.in/reader035/viewer/2022062321/56649db05503460f94a9e09d/html5/thumbnails/4.jpg)
CMS Quality VisionCMS Quality Vision
The right care for every person
every time
![Page 5: Centers for Medicare & Medicaid Services and Quality-Based Purchasing Kenneth S. Fink, MD, MGA, MPH Chief Medical Officer CMS Region X](https://reader035.vdocument.in/reader035/viewer/2022062321/56649db05503460f94a9e09d/html5/thumbnails/5.jpg)
CMS’ Quality Improvement CMS’ Quality Improvement Roadmap StrategiesRoadmap Strategies
• Work through partnerships• Measure quality and report comparative results
• Utilize pay for performance – improve quality and avoid unnecessary costs
• Encourage adoption of effective health information technology
• Promote innovation and the evidence base for effective use of technology
![Page 6: Centers for Medicare & Medicaid Services and Quality-Based Purchasing Kenneth S. Fink, MD, MGA, MPH Chief Medical Officer CMS Region X](https://reader035.vdocument.in/reader035/viewer/2022062321/56649db05503460f94a9e09d/html5/thumbnails/6.jpg)
• Rising costs drive focus to value• Current system rewards quantity, not quality
• Need to align payment structure with improved quality of care
• Facing fee schedule reduction• Payment reform receiving increased attention
CMS Current ContextCMS Current Context
![Page 7: Centers for Medicare & Medicaid Services and Quality-Based Purchasing Kenneth S. Fink, MD, MGA, MPH Chief Medical Officer CMS Region X](https://reader035.vdocument.in/reader035/viewer/2022062321/56649db05503460f94a9e09d/html5/thumbnails/7.jpg)
Increasing ExpendituresIncreasing Expenditures
Medicare Expenditures 1966-2004
0
50
100
150
200
250
300
350
1966
1969
1972
1975
1978
1981
1984
1987
1990
1993
1996
1999
2002
$ bi
llion
s
Total Expenditures
Physican and ClinicalServices
![Page 8: Centers for Medicare & Medicaid Services and Quality-Based Purchasing Kenneth S. Fink, MD, MGA, MPH Chief Medical Officer CMS Region X](https://reader035.vdocument.in/reader035/viewer/2022062321/56649db05503460f94a9e09d/html5/thumbnails/8.jpg)
Examples of Poor Quality Examples of Poor Quality CareCare
for those for those >>6565Medicare National
Mammogram in past 2 years
58 % 68 %
HgbA1c, eye exam and foot exam in past year
57 % 59 %
Pneumococcal vaccine
48 % 56 %
Nosocomial infections
2.8/1000 2.2/1000
From 2005 NHQR
![Page 9: Centers for Medicare & Medicaid Services and Quality-Based Purchasing Kenneth S. Fink, MD, MGA, MPH Chief Medical Officer CMS Region X](https://reader035.vdocument.in/reader035/viewer/2022062321/56649db05503460f94a9e09d/html5/thumbnails/9.jpg)
Medicare should care Medicare should care about qualityabout quality
• Increases benefit and reduces harm
• Decreases variation • Improves value• Improves health outcomes
![Page 10: Centers for Medicare & Medicaid Services and Quality-Based Purchasing Kenneth S. Fink, MD, MGA, MPH Chief Medical Officer CMS Region X](https://reader035.vdocument.in/reader035/viewer/2022062321/56649db05503460f94a9e09d/html5/thumbnails/10.jpg)
Strategies for Quality Strategies for Quality and Efficiency and Efficiency ImprovementImprovement
• Nonfinancial incentives• Financial incentives• Organizational redesign
– Quality Improvement Organizations
![Page 12: Centers for Medicare & Medicaid Services and Quality-Based Purchasing Kenneth S. Fink, MD, MGA, MPH Chief Medical Officer CMS Region X](https://reader035.vdocument.in/reader035/viewer/2022062321/56649db05503460f94a9e09d/html5/thumbnails/12.jpg)
Support for Support for Pay for PerformancePay for Performance
• President– FY 2006 budget
•“The Administration will take further steps to encourage excellence in care by exploring provider payment reforms that link quality to Medicare reimbursement in a cost neutral manner. Such payment reforms should be flexible enough to support innovations in health care delivery.”
– FY 2007 budget•Expansion of P4P initiatives
• Congress– Deficit Reduction Act provisions for hospitals, home health agencies, and a gainsharing demonstration
![Page 13: Centers for Medicare & Medicaid Services and Quality-Based Purchasing Kenneth S. Fink, MD, MGA, MPH Chief Medical Officer CMS Region X](https://reader035.vdocument.in/reader035/viewer/2022062321/56649db05503460f94a9e09d/html5/thumbnails/13.jpg)
Additional Support for Additional Support for Pay for PerformancePay for Performance
• MedPAC– “Medicare is ready to implement pay for performance as a national program and that differentiating among providers based on quality is a important first step towards purchasing the best care for beneficiaries and assuring the future of the program.”
• IOM– “New payment incentives must be created to encourage the redesign of structure and processes of care to promote higher value….Its purpose is to align payment incentives to encourage ongoing improvement in a way that will ensure high-quality care for all.”
![Page 14: Centers for Medicare & Medicaid Services and Quality-Based Purchasing Kenneth S. Fink, MD, MGA, MPH Chief Medical Officer CMS Region X](https://reader035.vdocument.in/reader035/viewer/2022062321/56649db05503460f94a9e09d/html5/thumbnails/14.jpg)
What does Pay for What does Pay for Performance mean to CMS?Performance mean to CMS?
• Mechanism for promoting better quality, while avoiding unnecessary costs
– Explicit payment incentives to achieve identified quality and efficiency goals
![Page 15: Centers for Medicare & Medicaid Services and Quality-Based Purchasing Kenneth S. Fink, MD, MGA, MPH Chief Medical Officer CMS Region X](https://reader035.vdocument.in/reader035/viewer/2022062321/56649db05503460f94a9e09d/html5/thumbnails/15.jpg)
• Measures– Quality, cost, patient experience– Valid and reliable– Evidence based
• Data Infrastructure– Collection– Analysis– Validation– Appeals
• Incentive Methodology– Individual measures or composite– Attainment and improvement– Bonus or differential– Funding source
Pay for Performance Pay for Performance ElementsElements
![Page 16: Centers for Medicare & Medicaid Services and Quality-Based Purchasing Kenneth S. Fink, MD, MGA, MPH Chief Medical Officer CMS Region X](https://reader035.vdocument.in/reader035/viewer/2022062321/56649db05503460f94a9e09d/html5/thumbnails/16.jpg)
P4R/P4P ProgramsP4R/P4P Programs
• Hospital Quality Initiative• Home Health Agency Pay for Reporting• Physician Voluntary Reporting Program (PVRP)
• Physician Resource Use• Medicaid
![Page 17: Centers for Medicare & Medicaid Services and Quality-Based Purchasing Kenneth S. Fink, MD, MGA, MPH Chief Medical Officer CMS Region X](https://reader035.vdocument.in/reader035/viewer/2022062321/56649db05503460f94a9e09d/html5/thumbnails/17.jpg)
Hospital Quality Alliance Hospital Quality Alliance (HQA)(HQA)
• Public-private collaboration of federal agencies, key hospital and health care organizations, and consumer groups– CMS, AHRQ, AHA, NQF, JCAHO, AMA, AFL-CIO, AARP
• Supports CMS’ implementation of hospital P4R/P4P
• Purpose is to adopt one robust, nationally standardized and prioritized set of measures, reported by every hospital in the country and accepted by all purchasers, overseers, and accreditors
![Page 18: Centers for Medicare & Medicaid Services and Quality-Based Purchasing Kenneth S. Fink, MD, MGA, MPH Chief Medical Officer CMS Region X](https://reader035.vdocument.in/reader035/viewer/2022062321/56649db05503460f94a9e09d/html5/thumbnails/18.jpg)
Hospital Quality Hospital Quality InitiativeInitiative
• MMA Section 501(b) – Authorized hospital pay for reporting– Payment differential of 0.4% for FYs 2005-07
– Starter set of 10 measures selected by HQA•AMI, HF, pneumonia, surgical infections
– Public reporting through CMS’ Hospital Compare website
– High participation rate (>98%) for small incentive
![Page 19: Centers for Medicare & Medicaid Services and Quality-Based Purchasing Kenneth S. Fink, MD, MGA, MPH Chief Medical Officer CMS Region X](https://reader035.vdocument.in/reader035/viewer/2022062321/56649db05503460f94a9e09d/html5/thumbnails/19.jpg)
Hospital Quality Hospital Quality InitiativeInitiative
• DRA Section 5001(a)– Payment differential of 2% for FYs 2007- – Expanded measure set, based on IOM’s December 2005 Performance Measures Report•Added HCAHPS
• DRA Section 5001(b)– Plan for hospital P4P beginning with FY 2009•Plan must consider: quality and cost measure development and refinement, data infrastructure, payment methodology, and public reporting
![Page 20: Centers for Medicare & Medicaid Services and Quality-Based Purchasing Kenneth S. Fink, MD, MGA, MPH Chief Medical Officer CMS Region X](https://reader035.vdocument.in/reader035/viewer/2022062321/56649db05503460f94a9e09d/html5/thumbnails/20.jpg)
Premier Hospital Quality Premier Hospital Quality Incentive DemonstrationIncentive Demonstration
• Involved more than 250 voluntary hospitals• Used 34 quality measures
– AMI, CABG, pneumonia, HF, hip/knee arthroplasty
• Top decile received 2% increase and second decile received 1% increase
• In year 3, those below year 1 ninth decile cut-off received 1% decrease and below tenth decile cut-off received 2% decrease
![Page 21: Centers for Medicare & Medicaid Services and Quality-Based Purchasing Kenneth S. Fink, MD, MGA, MPH Chief Medical Officer CMS Region X](https://reader035.vdocument.in/reader035/viewer/2022062321/56649db05503460f94a9e09d/html5/thumbnails/21.jpg)
Premier Hospital Quality Premier Hospital Quality Incentive DemonstrationIncentive Demonstration
CMS/Premier HQID Project Participants Composite Quality Score:
Trend of Quarterly Median (5th Decile) by Clinical Focus AreaOctober 1, 2003 - December 31, 2005 (Year 1 Final Data, Year 2 and Q4-05 Preliminary)
70.0
0%
64.1
0%
73.1
3%
68.1
1%
86.8
7%
93.6
5%
82.5
1%
77.8
8%
92.0
7%93.4
6% 94.8
4%
82.7
2%
81.5
7%
93.9
8%
95.0
7%
96.0
7%
84.8
1%
82.9
8%
95.3
7%
95.7
7%
96.8
5%
86.4
3%
84.3
8%
95.8
0%
95.9
8%
96.7
7%
88.5
4%
86.7
3%
96.0
5%
85.1
3%
89.8
8%
85.1
4%85
.92%
90.0
6%
89.0
%
73.1
%
78.3
%
91.5
%
88.9
% 90.5
%
76.2
%
80.0
%
92.6
%
90.0
%93.5
0%
60%
65%
70%
75%
80%
85%
90%
95%
100%
AMI CABG Pneumonia Heart Failure Hip and Knee
Clinical Focus Area
Co
mp
osi
te Q
ual
ity
Sco
re
Q4-03 Q1-04 Q2-04 Q3-04 Q4-04 Q1-05 Q2-05 Q3-05 Q4-05
![Page 22: Centers for Medicare & Medicaid Services and Quality-Based Purchasing Kenneth S. Fink, MD, MGA, MPH Chief Medical Officer CMS Region X](https://reader035.vdocument.in/reader035/viewer/2022062321/56649db05503460f94a9e09d/html5/thumbnails/22.jpg)
Home Health Agency P4RHome Health Agency P4R
• Authorized in DRA Section 5201• Begins in 2007• 2% payment differential for P4R• Public reporting on Home Health Compare website
• MedPAC Report to Congress on home health P4P by June 1, 2007
![Page 23: Centers for Medicare & Medicaid Services and Quality-Based Purchasing Kenneth S. Fink, MD, MGA, MPH Chief Medical Officer CMS Region X](https://reader035.vdocument.in/reader035/viewer/2022062321/56649db05503460f94a9e09d/html5/thumbnails/23.jpg)
Physician Fee SchedulePhysician Fee Schedule
• In 1992, the Medicare Fee Schedule took effect
• As part of the 1997 BBA, Congress created the Sustainable Growth Rate (SGR)
• Since 2002 the fee schedule would have resulted in negative annual updates without Congressional intervention
• Facing a 5% reduction for 2007
![Page 24: Centers for Medicare & Medicaid Services and Quality-Based Purchasing Kenneth S. Fink, MD, MGA, MPH Chief Medical Officer CMS Region X](https://reader035.vdocument.in/reader035/viewer/2022062321/56649db05503460f94a9e09d/html5/thumbnails/24.jpg)
Physician Voluntary Physician Voluntary Reporting Program (PVRP)Reporting Program (PVRP)
• An effort to begin to align payment with quality
• Involves submission of new codes on claims to reflect quality – Alternatively can participate in DOQ-IT
• Starter set of 16 measures to be expanded to include nearly all specialties
• Registrants receive confidential reports
![Page 25: Centers for Medicare & Medicaid Services and Quality-Based Purchasing Kenneth S. Fink, MD, MGA, MPH Chief Medical Officer CMS Region X](https://reader035.vdocument.in/reader035/viewer/2022062321/56649db05503460f94a9e09d/html5/thumbnails/25.jpg)
PVRP Initial MeasuresPVRP Initial Measures
• Aspirin at arrival for acute myocardial infarction
• Beta-blockers at arrival for acute myocardial infarction
• Hemoglobin A1c control for diabetes
• Low-density lipoprotein control for diabetes
• High blood pressure control for diabetes
• ACE inhibitors or ARBs for left ventricular systolic dysfunction
• Beta-blockers for history of acute myocardial infarction
• Falls assessment for elderly
• Antidepressants for depression
• Dialysis dose for ESRD• Hematocrit level for
ESRD• Arteriovenous fistula
for dialysis• Antibiotic prophylaxis
for surgery• Thromboembolism
prophylaxis for surgery• Internal mammary artery
use for CABG• Pre-operative beta-
blocker for isolated CABG
![Page 26: Centers for Medicare & Medicaid Services and Quality-Based Purchasing Kenneth S. Fink, MD, MGA, MPH Chief Medical Officer CMS Region X](https://reader035.vdocument.in/reader035/viewer/2022062321/56649db05503460f94a9e09d/html5/thumbnails/26.jpg)
• Beta-blocker therapy for patient with prior myocardial infarction– G8033 Patient taking a beta-blocker – G8034 Patient not taking a beta-blocker
– G8035 Patient not eligible for beta-blocker
Example: G-codesExample: G-codes
![Page 27: Centers for Medicare & Medicaid Services and Quality-Based Purchasing Kenneth S. Fink, MD, MGA, MPH Chief Medical Officer CMS Region X](https://reader035.vdocument.in/reader035/viewer/2022062321/56649db05503460f94a9e09d/html5/thumbnails/27.jpg)
• Beta-blocker therapy for patient with prior myocardial infarction– 4006F Patient taking a beta-blocker – 4006F-1P Patient not taking a beta-blocker for medical reasons
– 4006F-2P Patient not taking a beta-blocker for patient reasons
– 4006F-3P Patient not taking a beta-blocker for system reasons
Example: CPT-2 codesExample: CPT-2 codes
![Page 28: Centers for Medicare & Medicaid Services and Quality-Based Purchasing Kenneth S. Fink, MD, MGA, MPH Chief Medical Officer CMS Region X](https://reader035.vdocument.in/reader035/viewer/2022062321/56649db05503460f94a9e09d/html5/thumbnails/28.jpg)
Steps toward P4PSteps toward P4P
• Pay for reporting was hoped to begin in 2008 with pay for performance likely to follow
• Methodologies being developed– Calculating performance rates– Determining payments
• Ongoing issues– Practice or physician– Process or outcome– Accountability– Risk adjustment
![Page 29: Centers for Medicare & Medicaid Services and Quality-Based Purchasing Kenneth S. Fink, MD, MGA, MPH Chief Medical Officer CMS Region X](https://reader035.vdocument.in/reader035/viewer/2022062321/56649db05503460f94a9e09d/html5/thumbnails/29.jpg)
MedicaidMedicaid
• P4P is allowable and voluntary for state Medicaid programs
• At least 12 states have implemented P4P initiatives
• CMS will provide technical assistance to states
• CMS encourages states to evaluate their P4P programs
![Page 31: Centers for Medicare & Medicaid Services and Quality-Based Purchasing Kenneth S. Fink, MD, MGA, MPH Chief Medical Officer CMS Region X](https://reader035.vdocument.in/reader035/viewer/2022062321/56649db05503460f94a9e09d/html5/thumbnails/31.jpg)
Improving EfficiencyImproving Efficiency
• MedPAC recommends:– "CMS should use Medicare claims data to measure fee-for-service physicians' resource use and share results with physicians confidentially to educate them about how they compare with aggregated peer performance."
• CMS created the Physician Resource Use Workgroup
![Page 32: Centers for Medicare & Medicaid Services and Quality-Based Purchasing Kenneth S. Fink, MD, MGA, MPH Chief Medical Officer CMS Region X](https://reader035.vdocument.in/reader035/viewer/2022062321/56649db05503460f94a9e09d/html5/thumbnails/32.jpg)
Efficiency EffortsEfficiency Efforts
• Prospective Payment System• Physician Resource Use Reports• Episode Grouper software evaluation
![Page 33: Centers for Medicare & Medicaid Services and Quality-Based Purchasing Kenneth S. Fink, MD, MGA, MPH Chief Medical Officer CMS Region X](https://reader035.vdocument.in/reader035/viewer/2022062321/56649db05503460f94a9e09d/html5/thumbnails/33.jpg)
Prospective Payment Prospective Payment SystemSystem
• Pays a predetermined, fixed amount– acute inpatient hospitals – home health agencies– hospice– hospital outpatient – inpatient psychiatric facilities – inpatient rehabilitation facilities– long-term care hospitals– skilled nursing facilities
• Excludes physician services
![Page 34: Centers for Medicare & Medicaid Services and Quality-Based Purchasing Kenneth S. Fink, MD, MGA, MPH Chief Medical Officer CMS Region X](https://reader035.vdocument.in/reader035/viewer/2022062321/56649db05503460f94a9e09d/html5/thumbnails/34.jpg)
Cost of CareCost of Care Measurement Goals Measurement Goals
• To develop meaningful, actionable, and fair cost of care measures of actual to expected physician resource use
• To link cost of care measures to quality of care measures for a comprehensive assessment of physician performance
![Page 35: Centers for Medicare & Medicaid Services and Quality-Based Purchasing Kenneth S. Fink, MD, MGA, MPH Chief Medical Officer CMS Region X](https://reader035.vdocument.in/reader035/viewer/2022062321/56649db05503460f94a9e09d/html5/thumbnails/35.jpg)
Resource Use ReportsResource Use Reports
• Used for highly utilized imaging services– Phase I: Echocardiograms for Heart
Failure– Phase II: MRs/CTs for Neck Pain
• Lessons learned• Limitations to use of claims data• Costs of reports likely to outweigh
benefits• Could be used to identify outliers
![Page 36: Centers for Medicare & Medicaid Services and Quality-Based Purchasing Kenneth S. Fink, MD, MGA, MPH Chief Medical Officer CMS Region X](https://reader035.vdocument.in/reader035/viewer/2022062321/56649db05503460f94a9e09d/html5/thumbnails/36.jpg)
Episode Grouper Episode Grouper EvaluationEvaluation
• To understand episode grouper technology and its potential uses
• To compare and contrast the characteristics of selected, commercially-available episode groupers
• To determine which grouper, if any, best defines comparable episodes of care at the individual physician level for the Medicare population
![Page 37: Centers for Medicare & Medicaid Services and Quality-Based Purchasing Kenneth S. Fink, MD, MGA, MPH Chief Medical Officer CMS Region X](https://reader035.vdocument.in/reader035/viewer/2022062321/56649db05503460f94a9e09d/html5/thumbnails/37.jpg)
Episode Grouper Episode Grouper EvaluationEvaluation
• Phase I: Data Configuration Issues– Focusing on six conditions
1.Diabetes 4. Stroke2.Heart failure 5. Prostate cancer3.COPD 6. Hip fracture
• Phase II: Risk Adjustment• Phase III: Groupers as Physician
Resource Use Reporting Tools
![Page 38: Centers for Medicare & Medicaid Services and Quality-Based Purchasing Kenneth S. Fink, MD, MGA, MPH Chief Medical Officer CMS Region X](https://reader035.vdocument.in/reader035/viewer/2022062321/56649db05503460f94a9e09d/html5/thumbnails/38.jpg)
Some P4P Some P4P DemonstrationsDemonstrations
• Physician Group Practice• Medicare Hospital Gainsharing • Medicare Care Management Performance
• Medicare Health Care Quality
![Page 39: Centers for Medicare & Medicaid Services and Quality-Based Purchasing Kenneth S. Fink, MD, MGA, MPH Chief Medical Officer CMS Region X](https://reader035.vdocument.in/reader035/viewer/2022062321/56649db05503460f94a9e09d/html5/thumbnails/39.jpg)
Physician Group Physician Group PracticePractice
• Authorized by BIPA 2000• 3 year project to incentivize care coordination for chronically ill and high cost beneficiaries in an efficient manner
• Groups share in financial savings of actual spending compared to target spending
• Addresses DM, HF, CAD, and prevention• Ten group practices representing 5,000 physicians and 200,000 Medicare beneficiaries– Everett Clinic
![Page 40: Centers for Medicare & Medicaid Services and Quality-Based Purchasing Kenneth S. Fink, MD, MGA, MPH Chief Medical Officer CMS Region X](https://reader035.vdocument.in/reader035/viewer/2022062321/56649db05503460f94a9e09d/html5/thumbnails/40.jpg)
Medicare Hospital Medicare Hospital GainsharingGainsharing
• Authorized by DRA 2005• Allows gainsharing between hospitals and physicians
• Aligns incentives between hospitals and physicians to improve quality and efficiency
• 3 year project involving 6 sites, 2 of which are rural
![Page 41: Centers for Medicare & Medicaid Services and Quality-Based Purchasing Kenneth S. Fink, MD, MGA, MPH Chief Medical Officer CMS Region X](https://reader035.vdocument.in/reader035/viewer/2022062321/56649db05503460f94a9e09d/html5/thumbnails/41.jpg)
Medicare Care Management Medicare Care Management PerformancePerformance
• Authorized by MMA 2003• P4P pilot with physicians to promote adoption and use of health information technology to improve quality
• Bonus payments made for meeting performance standards in DM, HF, CAD, and prevention
• 3 year project targeting small and medium sized practices participating in DOQ-IT and located in CA, AR, MA, and UT
![Page 42: Centers for Medicare & Medicaid Services and Quality-Based Purchasing Kenneth S. Fink, MD, MGA, MPH Chief Medical Officer CMS Region X](https://reader035.vdocument.in/reader035/viewer/2022062321/56649db05503460f94a9e09d/html5/thumbnails/42.jpg)
Medicare Health Care Medicare Health Care QualityQuality
• Authorized by MMA 2003• 5 year project testing major changes to improve quality and efficiency across a health care system
• Also addresses patient safety, effectiveness, patient-centeredness, timeliness, and equity
• Participating entities include physician groups, integrated delivery systems, and regional health care consortia
![Page 43: Centers for Medicare & Medicaid Services and Quality-Based Purchasing Kenneth S. Fink, MD, MGA, MPH Chief Medical Officer CMS Region X](https://reader035.vdocument.in/reader035/viewer/2022062321/56649db05503460f94a9e09d/html5/thumbnails/43.jpg)
SummarySummary
• CMS is committed to improving quality and efficiency
• CMS’ roadmap for improving quality and efficiency includes – Moving forward through partnerships
– Using financial incentives– Reporting measures publicly– Encouraging adoption of health information technology
![Page 44: Centers for Medicare & Medicaid Services and Quality-Based Purchasing Kenneth S. Fink, MD, MGA, MPH Chief Medical Officer CMS Region X](https://reader035.vdocument.in/reader035/viewer/2022062321/56649db05503460f94a9e09d/html5/thumbnails/44.jpg)
“The entire concept of pay for performance is offensive. We shouldn’t ever expect anyone to get paid more for
doing what they were . . . paid to do,” he said. Medicare “must demand the highest quality and no less.” Quality should be expected “from each and every provider. And my solution would be to the provider who can’t provide quality care, to defrock
‘em.”
Representative Stark as reported in CQ HealthBeat
![Page 45: Centers for Medicare & Medicaid Services and Quality-Based Purchasing Kenneth S. Fink, MD, MGA, MPH Chief Medical Officer CMS Region X](https://reader035.vdocument.in/reader035/viewer/2022062321/56649db05503460f94a9e09d/html5/thumbnails/45.jpg)
ResourcesResources
• Kenny Fink– [email protected]– 206-615-2390
• http://www.cms.hhs.gov/QualityInitiativesGenInfo/
• http://www.cms.hhs.gov/DemoProjectsEvalRpts/MD/list.asp
• http://www.cms.hhs.gov/QualityImprovementOrgs/• http://www.cms.hhs.gov/MedicaidSCHIPQualPrac/