Participation in the CMS Premier Hospital Quality Incentive Demonstration (HQID) project has been a catalyst for quality improvement at the North Shore-LIJ Health System in Great Neck, New York. This was reported by Lawrence G. Smith M.D., Chief Medical Officer and Dean of the Hofstra University School of Medicine when he testified on behalf of Premier Healthcare Alliance before the House Ways and Means Committee on April 1.
North Shore-LIJ has been part of the Premier demonstration project where CMS encouraged improvements in hospital quality by testing quality incentives across a broad array of acute care conditions in Medicare patients. The project started in 2003 and was extended through 2009.
The hospitals in the North Shore-LIJ system were charged with developing standardized care for high volume, high-risk, and problem prone conditions emphasizing process and outcome measures. Established benchmarks were created and communicated horizontally and vertically from the bedside caregivers across the organization to the Board of Trustees.
The health system created interdisciplinary task forces to share best practices and lessons learned. In addition, disease-specific toolboxes were created containing various forms, documents, and teaching materials, which were then disseminated to each site. North Shore-LIJ used its corporate university called the “Center for Learning and Innovation” to provide education, knowledge transfer, and team building for employees.
LIJ achieved improvement in patients with heart attacks, heart failure, pneumonia, coronary artery bypass grafts, and with hip and knee replacements. Preliminary findings for year four of the project indicated that eight out of nine North Shore-LIJ hospitals have reached the attainment threshold in all clinical conditions. During the first three years of the project, the hospitals received incentive payments totaling $1,134,120 for the quality achievement for five of the nine providers.
The health system obtained success by having performance measures reported to senior leadership, local leadership, and to all levels of staff. Data is also posted on the health system’s intranet. To search for opportunities for improvement, the health system continuously monitors performance by comparing data among their own facilities and benchmarking it against other healthcare organizations.
Dr. Smith emphasized how important it is for quality reporting to be automated and to be based on medical records data. The current process for reporting quality indicators is a dual process that relies heavily on manually abstracting clinical data, reviewing medical record review information, and then reconciling administrative data. This is both time consuming and costly to the organization. Also, because data is coming from medical records and billing information, this process can lead to errors and inaccuracies. The funding through the Recovery Act will help as more advanced health information technology systems will be implemented within the facilities.
Dr. Smith concluded by saying, “Quality incentives can and do improve patient outcomes across a wide variety of measures and payers. As we learned through HQID, if tested and piloted first to ensure that appropriate incentives are in place with provider interests aligned, we can achieve remarkable advances to improve safety, quality, and affordability of care.”