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APHA Scientific Session and Event Listing

Recorded presentation

Samuel O. Ogunbo, PhD¹, Nikolas Matthes, MD, PhD, MPH², Carlos Alzola, MS³, Jen-Hao Cheng, PhD¹, and Devi Sinha, BS¹. (1) Research & Development, Quality Indicator Project / Maryland Hospital Association, 6820 Deerpath Rd, Elkridge, MD 21075, 410-540-5054, sogunbo@mhaonline.org, (2) Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21205, (3) Data Insights, 401 SE Glyndon St., Vienna, VA 22180

The CMS/Premier Hospital Quality Incentive Demonstration Project is the first national effort by CMS to award Pay-for-Performance bonuses to top-performing hospitals. This study assesses the CMS Composite Quality Score (CQS) methodology used in identifying top-performers and the implications that its use may have on bonus payments to hospitals.

Heart failure data collected from 475 hospitals by the Quality Indicator Project (QI) during 2005 were used for the analysis. The main outcome of the analysis was the identification of the top-performers using composite scores calculated by the CQS method. Implications for hospital ranking and bonus payment were determined using the associated composite gap. A composite gap was defined as the difference between composite denominator and composite numerator.

Except in instances where the composite gap is zero, there is considerable variance in the composite scores (range: 0.12 to 0.99) for hospitals with similar composite gap. Using the suggested 1st and 2nd deciles (scores =.98 and = 0.95, respectively) as thresholds for determining who gets bonus payment, we found that 21 hospitals (4.4%) would have been favored incorrectly for 2 percent bonus payment, while 18 hospitals (3.8%) would have been incorrectly financially disadvantaged by reduced payment.

The results from this study have important implications since it is likely that CMS may implement the program on a broad scale following the pilot.

Learning Objectives: