Driven by insurers that are introducing pay for performance programs that tie together provider accountability and
reimbursement in the form of incentive programs that reward efficient and superior care, hospitals are determining how these
new reimbursement strategies can impact their bottom line.
as one-third of commercial plans now have
implemented some pay for performance
methods, according to PricewaterhouseCoopers. Most importantly, Medicare, the
nationís largest payer, is headed down that
path with its Hospital Quality Initiative
and a pilot program with members of the
Premier alliance of not-for-profit hospitals. Under this pilot program the Centers for Medicare and Medicaid Services (CMS) will provide financial awards to hospitals that show high-quality performance in a number of acute care areas. The hospitals will use evidence-based clinical protocols to treat patients with pneumonia, heart failure, coronary artery bypass graft, hip/knee replacement and myocardial infarction. During the pilot program, CMS will calculate the performance of participating hospitals in treating these five conditions using established protocols. Hospitals will be scored on the quality measures related to each condition, and those hospitals in the top 10 percent for a given condition will be given a 2 percent bonus on their Medicare payments. Hospitals in the second 10 percent will be given a 1 percent bonus. Hospitals in the remainder of the top 50 percent will be given recognition for their quality but no bonus.
The success of this pilot program will determine if CMS will move toward a performance-based reimbursement system, even as health plans are already tying quality of care to their contracts with healthcare providers.
Developing Consistent and Effective Organization-wide Performance Improvement Through Hospital-Based Performance Programs,
an October 13th audio conference on CD-ROM, examines what steps hospitals need to take to succeed with this type of reimbursement
Dr. Manuel Lowenhaupt, National Practice Leader, Clinical Transformation for CAP GEMINI, provides the
details you need on:
- the hospital's role in pay for performance programs;
- benchmarks and metrics for hospitals;
- lessons learned;
- implementing clinical systems improvement and controls to collect and report on provider performance;
- solving the trend of declining provider reimbursement through pay-for-performance contracting;
- gaining buy-in from physicians through infrastructure and technology implementation; and
- balancing the various reporting requirements -- NCQA, JCAHO, state association, health plan reporting.
You can "attend" this program right in your office and enjoy significant savings Ė no travel time or hassle; no hotel expenses. Itís so convenient! Invite your staff members to listen to this information packed CD-ROM.
Who Will Benefit from this audio-conference?
CEOs, CFOs, chief medical officers, chief nursing officers, medical directors, quality improvement executives, disease management directors, managers and coordinators, health plan executives, care management nurses, strategic planning directors, and physician organizations.
Click here to save $99 on the CD-ROM if you participated in the live program.
About Your Panelist:
Dr. Lowenhaupt is a Vice President at Cap Gemini and the National Practice Leader for Clinical Transformation. Dr. Lowenhaupt is internationally noted for his work in clinical effectiveness, care management, and clinical informatics.
In his 14 years of consulting, he has worked with greater than one hundred twenty healthcare organizations in the United States, Canada, Europe, and the Far East.
Dr. Lowenhaupt received his undergraduate degree, Phi Beta Kappa, from M.I.T. and his medical degree from Harvard Medical School. He studied informatics at the Massachusetts General Hospital (where he was a Clinical Fellow) and has held teaching positions at M.I.T., Boston University School of Medicine, and Harvard Medical School.