Outcome and Payment Measures

Background

In the interest of promoting high-quality, patient-centered care and accountability, the Centers for Medicare & Medicaid Services (CMS) collaboratively with Hospital Quality Alliance (HQA) began publicly reporting 30-day risk-standardized mortality measures for acute myocardial infarction (AMI) and heart failure (HF) in June 2007. CMS has since expanded the publicly reported outcome measures to include more conditions and procedures, and to include the 30-day readmission, 90-day complications, and excess days in acute care (EDAC) measures as well as payment measures. Publicly reporting and displaying these measures through its quality improvement initiatives improves the care provided by the nation’s hospitals, increases the transparency, and provides quality information to consumers and others. CMS annually calculates the following outcome and payment measures based on claims and administrative data for public reporting:

Acronyms:

AMI: Acute Myocardial Infarction, CABG: Coronary Artery Bypass Graft, COPD: Coronary Obstructive Pulmonary Diseases, HF: Heart Failure, THA/TKA: Total Hip Arthroplasty and/or Total Knee Arthroplasty, PN: Pneumonia, HW: Hospital Wide.

Additional Analyses

In addition to calculating the above measures for public reporting, CMS also conducts annual analyses of its hospital outcome measures to provide greater insight into measure trends and variation. These additional analyses use calculations reported annually on Hospital Compare and are compiled in the Chartbook as described below.

Hospital Performance Reports on Risk-Standardized Outcome Measures: Chartbook Series

The CMS Hospital Performance Reports present analyses that provide insight into hospital performance on publicly reported risk-standard outcome measures for patients. The Chartbook provides new information about recent trends and variation in outcomes by location, hospital characteristics, patient disparities, and cost.

The Chartbook for the claims-based, hospital-level readmission, mortality, complications, payment, and excess days in acute care (EDAC) measures has been transformed into a website that contains eight interactive data visualizations: www.CMSHospitalChartbook.com. These visualizations have been updated with measure results from the latest performance year for which data is available. The Chartbook:

• Displays national trends and distributions of hospital performance on outcomes measures.
• Highlights regional variation in performance on outcomes measures.
• Compares the performance of hospitals by the following hospital characteristics: teaching hospitals, safety-net hospitals, hospitals with high proportions of African-American patients, hospitals with high proportions of low income patients, hospital size, hospital ownership, and urban/rural hospitals.
• Identifies the number of hospitals that care for a disproportionate volume of patients with social risk factors.
• Examines how consistently hospitals perform on pairs of outcome measures.
• Reports variation in risk-standardized Medicare payments for treatment for selected condition- and procedure-specific episodes of care.
• Explores how a state’s overall performance on measures relates to their performance for patients with and without social risk factors.