Becker's Clinical Quality & Infection Control

61 QUALITY IMPROVEMENT & MEASUREMENT Increased hospital payments linked to better heart attack outcomes: 4 things to know By Megan Knowles H igher 30-day spending to care for Medicare beneficiaries who recently experienced a heart attack is linked to a slight reduction in patient mortality, according to a study published in Circulation: Cardiovascular Quality and Outcomes. Researchers at the Smith Center for Out- comes Research in Cardiology at Bos- ton-based Beth Israel Deaconess Medical Center led the study. Here are four things to know. 1. e study examined the relationship between 30-day episode spending for inpa- tient and post-discharge care and patient mortality following a patient's admission to a hospital for a heart attack. 2. e researchers used national Medicare claims data to analyze over 640,000 hospital- izations involving patients 65 years or older who were hospitalized for a heart attack at an acute care hospital between July 2011 and June 2014. 3. "Recent policy efforts have focused on im- proving the value of care, both in terms of to- tal spending and patient outcomes," said se- nior corresponding author Robert Yeh, MD. "We need to understand whether programs like the Hospital Value-Based Purchasing Program are able to globally reduce spending and improve outcomes for acute conditions like [heart attacks], or whether the strong incentive to reduce hospital spending has unintended adverse consequences." 4. e study's findings also have significant implications for patient care, said first author Rishi Wadhera, MD. "While this study found that increased spending was associated with better outcomes, not all spending is of equal value and further research is needed to find out why higher-spending hospitals have better outcomes." n Why chance alone may identify HAC program's low-performing hospitals By Megan Knowles C hance may significantly contribute to a hospital's penalty status in the CMS' Hospital-Acquired Conditions Reduction Program, according to a study published in Journal for Healthcare Quality. The study authors analyzed data from the CMS Hospital Compare website to simulate the consistency of hospitals' scores and how penalties were assigned under repeated measurement, with no change in each hospital's underlying quality. The simulation found only around 40 percent of the 768 hospitals subject to the program's payment penalty last year had scores that were statistically different from the threshold penalty score. "In other words, the majority of hospitals receiving a HAC penalty have per- formance indistinguishable from those that are not being penalized," Nancy Foster, American Hospital Association vice president for quality and patient safety policy, wrote in a blog post. The proportion of hospitals statistically different from the threshold showed significant variation when examining several factors, including the hospital's ownership status, teaching status and bed size. The study also found that due only to chance, 18 percent of penalized hospitals would escape penalty on repeated measurement. The study authors suggest policymakers consider altering the HAC-RP to improve its reliability. n CMS to offer $30M in grants to develop new quality measures By Megan Knowles C MS will provide up to $30 million in funding and technical assistance to clinicians, patients and other stakeholders to support the develop- ment of quality measures over three years, Kate Goodrich, MD, CMS' CMO and director of the agency's Center for Clinical Standards and Quality, wrote in a March 2 statement. CMS aims to develop, improve, update and expand quality measures for use in the Quality Payment Program through the funding initiative. CMS will partner with external entities, including clinical specialty societies, clinical professional organizations, patient advocacy organizations, educa- tional institutions, independent research organizations and health systems to improve these measures. The partnership aims to address issues in clinician engagement, provider burden, consumer-informed decisions, critical measure gaps, quality mea- sure alignment and efficient data collection. "By giving external entities needed resources to help guide their mea- sure-development efforts though [sic] this funding opportunity, CMS can leverage the unique perspectives and expertise of these external entities, such as clinician and patient perspectives, to advance the Quality Payment Program measure portfolio," Dr. Goodrich wrote. n

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