Core Measures: Get Used to It

Cheryl Clark, for HealthLeaders Media , September 14, 2009

The idea of calculating compliance with core measures will become increasingly important as health plans and government payers reward providers for meeting certain benchmarks, and processes of care that are believed to lead to higher quality and better outcomes for patients.

"To date, the only certainty in reform is reduced reimbursement for providers, particularly hospitals," according to the Data Advantage Report. It adds that savings will come from increased efficiencies. "One conclusion of this release of the Hospital Value Index benchmarks is that approximately 9.3% of all hospitals' costs could be eliminated if all U.S. hospitals achieved the HVI benchmarks."

The authors of the study acknowledged that many hospital executives and physicians are skeptical that meeting such requirements can equate with better care. But they added that even those skeptics should realize that the changes are coming.

"The decline is attributable to a series of industry initiatives ranging from increased compliance requirements, to the introduction of greater transparency, and on new measures that are being monitored that will support the implementation of value based purchasing," they wrote.

For example, nearly 3,000 hospitals must now comply with federal requirements for disclosing and actively reporting on sets of quality measures, a number of facilities that has doubled since the 2008 report.

Also the report includes enhanced 30-day mortality rate scores and the introduction of measures that rank hospitals for the number of re-admissions within 30 days.

The data used for scoring came from publicly available government agency-run sources. It included:

  • Patient safety scores as defined by the Agency for Healthcare Research and Quality, which includes information from approximately 12 million Medicare discharges.
  • Medicare Hospital Outpatient Prospective Payment System data, which includes 54 million hospital-based outpatient Medicare claims.
  • Hospital Consumer Assessment of Healthcare Providers and Systems patient experience reports.
  • Hospital 30-day readmission rates collected by the Centers for Medicare and Medicaid Services.
  • Post-discharge hospital mortality collected by the CMS Hospital Outcome of Care dataset.
  • Information based on patient perception provided by Ticker Division of the National Research Corporation.

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