Pay for Performance: A Medicare Priority

Pay for Pay for Performance:Performance:A Medicare A Medicare

PriorityPriorityRewarding the right care for Rewarding the right care for every person, every timeevery person, every time

Center for Medicare and Center for Medicare and Medicaid ServicesMedicaid Services

AgendaAgenda

Pay for Performance (P4P) and the Pay for Performance (P4P) and the CMS Quality Agenda CMS Quality Agenda

P4P: the next step to improving P4P: the next step to improving qualityquality

CMS P4P DemonstrationsCMS P4P Demonstrations Challenges Challenges

Why Pay for Why Pay for Performance?Performance?

Rising costs driving focus to quality, Rising costs driving focus to quality, valuevalue

Current system rewards quantity, not Current system rewards quantity, not qualityquality

Private sector initiativesPrivate sector initiatives Public sector interestPublic sector interest

CongressCongress Administration and HHS / CMS leadership Administration and HHS / CMS leadership States States

CMS Vision: Quality CMS Vision: Quality ImprovementImprovement

Provide leadership in improving Provide leadership in improving American health careAmerican health care

The right care for every personThe right care for every personevery timeevery time

Safe, effective, timely, patient-Safe, effective, timely, patient-centered, efficient and equitablecentered, efficient and equitable(IOM recommendations)(IOM recommendations)

Partners are keyPartners are key

CMS Quality InitiativesCMS Quality Initiatives

HospitalsHospitals Physician OfficesPhysician Offices

Nursing HomesNursing Homes Home Health CareHome Health Care End-stage Renal Disease Treatment End-stage Renal Disease Treatment

(ESRD)(ESRD)

P4P: The Next Step in P4P: The Next Step in Improving QualityImproving Quality

Data collection infrastructure in Data collection infrastructure in placeplace

Pay for reporting encouraged Pay for reporting encouraged some providerssome providers

Quality data now readily Quality data now readily availableavailable

P4P Issues for CMSP4P Issues for CMS What to rewardWhat to reward

Relative qualityRelative quality Absolute thresholdAbsolute threshold ImprovementImprovement

How to finance incentivesHow to finance incentives Across-the-board reduction to create Across-the-board reduction to create

poolpool Offsetting penaltiesOffsetting penalties Offsetting savingsOffsetting savings

P4P Benefits for P4P Benefits for ProvidersProviders

BenefitsBenefits Rewards superior performance and Rewards superior performance and

encourages overall improvementencourages overall improvement Aligns financial model to professional Aligns financial model to professional

goals of quality improvementgoals of quality improvement Focus on volume is diminished as focus Focus on volume is diminished as focus

on quality is heightenedon quality is heightened

Current CMS Current CMS Demonstrations and P4P Demonstrations and P4P

ActivitiesActivities Hospital Voluntary ReportingHospital Voluntary Reporting Premier Hospital Quality Incentive Premier Hospital Quality Incentive

DemonstrationDemonstration Physician Voluntary Reporting Program Physician Voluntary Reporting Program

(PVRP)(PVRP) Physician Group Practice DemonstrationPhysician Group Practice Demonstration Section 649 MCMP DemonstrationSection 649 MCMP Demonstration Chronic Care / Nursing Home P4P Chronic Care / Nursing Home P4P Section 646 Medicare Health Care Quality Section 646 Medicare Health Care Quality

Demo.Demo.

Current CMS Current CMS Demonstrations and P4P Demonstrations and P4P

ActivitiesActivities Home Health P4P (in development)Home Health P4P (in development) ESRD Bundled Payment DemonstrationESRD Bundled Payment Demonstration Section 721 Chronic Care Improvement Section 721 Chronic Care Improvement

ProgramProgram Care Management for High Cost Care Management for High Cost

BeneficiariesBeneficiaries

Home Health Home Health P4PP4P

What’s nextWhat’s next

HHA Current Status and HHA Current Status and PreparednessPreparedness

Deficit Reduction Act:Deficit Reduction Act: HHAs shall submit to the Secretary HHAs shall submit to the Secretary

such data that the Secretary such data that the Secretary determines are appropriate for the determines are appropriate for the measurement of health care quality. measurement of health care quality.

The Secretary shall establish The Secretary shall establish procedures for making data procedures for making data submitted under subclause (II) submitted under subclause (II) available to the public.available to the public.









What Does DRA Mean for What Does DRA Mean for HHAs?HHAs?

CMS, MedPac and AHRQCMS, MedPac and AHRQ11 agree that agree that the current Outcome and the current Outcome and Assessment Information Set (OASIS) Assessment Information Set (OASIS) provide qualitative information on provide qualitative information on how home health agencies provide how home health agencies provide care.care.

(1) July 27, 2005 Medicare Payment Advisory Commission (MedPac) testimony before the Senate Committee on Finance, U. S. Senate on pay for performance in Medicare

What Does DRA Mean for What Does DRA Mean for HHAs?HHAs?

CMS shall continue to utilize the CMS shall continue to utilize the Home Health CompareHome Health Compare22 website website whereby home health agencies are whereby home health agencies are listed geographically, so consumers listed geographically, so consumers can search for all Medicare-can search for all Medicare-approved home health providers that approved home health providers that serve their city or zip code and then serve their city or zip code and then find the agencies offering the types find the agencies offering the types of services they need.of services they need.

(2) http://www.medicare.gov/HHCompare/Home/

DRA To-Do ListDRA To-Do List

Define the reporting period for DRA Define the reporting period for DRA that allows payments to be adjusted that allows payments to be adjusted

Conduct the data analysis necessary Conduct the data analysis necessary to develop the list of HHAs eligible to develop the list of HHAs eligible for the 2% market basket increasefor the 2% market basket increase

Ensure that HHAs not represented Ensure that HHAs not represented by OASIS data are not penalized.by OASIS data are not penalized.

Beyond DRABeyond DRAPay-for-PerformancePay-for-Performance

In order to support and implement a In order to support and implement a P4P Program in Home Health, we P4P Program in Home Health, we are focusing on 4 areas of work:are focusing on 4 areas of work: Performance ModelPerformance Model Payment MethodologyPayment Methodology Data InfrastructureData Infrastructure Program Transparency and Public Program Transparency and Public

ReportingReporting

Next Steps: Pay-for-Next Steps: Pay-for-PerformancePerformance

Performance Model:Performance Model: What type of performance model will be What type of performance model will be

applied to P4P?applied to P4P? Achievement (Quality Improvement)Achievement (Quality Improvement) Attainment (Threshold/Benchmarks)Attainment (Threshold/Benchmarks) Achievement + AttainmentAchievement + Attainment

MedPac Report on value-based MedPac Report on value-based purchasing – June 2007purchasing – June 2007

Performance ModelPerformance Model

Achievement:Achievement: Establishes an expectation of performance Establishes an expectation of performance

improvement based on HHA performance improvement based on HHA performance on identified set of OASIS outcome on identified set of OASIS outcome measures, past performance, etc:measures, past performance, etc:

For example: For example: Incentive payments based on a specific Incentive payments based on a specific

percentage improvement within one or more percentage improvement within one or more quality measures:quality measures:

HHAs would only be rewarded if a significant HHAs would only be rewarded if a significant number of their patient base experienced number of their patient base experienced improvement in their ability to manage oral improvement in their ability to manage oral medications.medications.

Performance ModelPerformance Model

Attainment:Attainment: Establishes an threshold of performance Establishes an threshold of performance

based on averages (national, geographic, based on averages (national, geographic, home health agency characteristics, or other home health agency characteristics, or other demographic).demographic).

For example:For example: Incentive payments on reaching a threshold Incentive payments on reaching a threshold

relative to an HHA’s within a specific quality relative to an HHA’s within a specific quality measure:measure:

HHAs would only be rewarded if their patient base (on HHAs would only be rewarded if their patient base (on average) is able to manage oral medications at the same average) is able to manage oral medications at the same risk-adjusted rate as their industry peers.risk-adjusted rate as their industry peers.


Payment Methodology:Payment Methodology: What type of payment methodology will What type of payment methodology will

be applied to P4P?be applied to P4P? Awaiting MedPac report Awaiting MedPac report

recommendationsrecommendations Awaiting Congressional actionAwaiting Congressional action


Data Infrastructure:Data Infrastructure: Data collection tool – OASISData collection tool – OASIS

Update current measuresUpdate current measures Expand to collect additional outcome and Expand to collect additional outcome and

process measuresprocess measures Patient experience of care dataPatient experience of care data Maintain QIES data repository contract Maintain QIES data repository contract

and measureand measure Plan for future Integrated Data Plan for future Integrated Data

Repository (IDR)Repository (IDR)


Program Transparency and Public Program Transparency and Public Reporting:Reporting: Nationally endorsed measuresNationally endorsed measures

ExpansionExpansion DRA:DRA:

The Secretary shall establish procedures for The Secretary shall establish procedures for making data submitted under subclause (II) making data submitted under subclause (II) available to the public.available to the public.

Home Health P4P Home Health P4P DemonstrationDemonstration

Anticipated voluntary, implemented Anticipated voluntary, implemented on a state-wide basison a state-wide basis

Budget-neutralBudget-neutral Home Health Quality AllianceHome Health Quality Alliance

Industry stakeholdersIndustry stakeholders ConsumersConsumers Payers and Health PlanPayers and Health Plan

Home Health Measures Home Health Measures ExpansionExpansion

CMS will work with stakeholdersCMS will work with stakeholders

Focus is on measuring patient Focus is on measuring patient experience, outcomes and efficiencyexperience, outcomes and efficiency

In ConclusionIn Conclusion Medicare increasing focus on qualityMedicare increasing focus on quality P4P is here to stay - widespread supportP4P is here to stay - widespread support Multiple demonstration projects Multiple demonstration projects

underway / in developmentunderway / in development Early results confirm improved quality Early results confirm improved quality

outcomes using P4Poutcomes using P4P P4P can help preserve the Medicare P4P can help preserve the Medicare

trust fundtrust fund Partners are key to success – CMS Partners are key to success – CMS

needs everyoneneeds everyone

““We are seeing that pay-for-We are seeing that pay-for-performance works. We are seeing performance works. We are seeing increased quality of care for patients, increased quality of care for patients, which will mean fewer costly which will mean fewer costly complications – exactly what we complications – exactly what we should be paying for in Medicare.”should be paying for in Medicare.”

Mark B. McClellan, MD, PhD Mark B. McClellan, MD, PhD

CMS AdministratorCMS Administrator

Documents

Pay for Performance: A Medicare Priority