“In a pay-for-performance world, you need IT tools to help with core measures and DRG [diagnosis-related group] documentation, which will improve clinical and financial results dramatically.”
Ron Greeno, MD, CMO of Cogent Healthcare in Los Angeles, is dubious about tying core measures compliance to the presence of hospitalists. “The core measures are CMS’ attempt to devise a statistical representation of everything clinically relevant that a doctor does,” he says. “It’s like a quiz at school. You can memorize answers to the quiz without learning the subject … . It’s measuring quality by proxy.”
The fact that “hospitalist program” applies to a wide range of programs—from one emergency department doctor admitting patients to full-blown, highly organized, and well-resourced hospital medicine groups, also muddies the waters. “Comparing them on core measure compliance is not science,” concludes Dr. Greeno.
Team Health’s Dr. Goldsholl says that while hospitalists enhance core measures compliance many hospitals throw other resources at improving core measures compliance without much to show for it.
“Some hospitals have case managers telling doctors that they can’t discharge a patient without documenting core measure compliance, or [they] have hired one case manager per core measure,” she explains. “Others issue MD report cards. Some [hospitals] without strong quality improvement departments and strong governance aren’t sure what to do.”
Dr. Goldsholl points out that hospitalists, who routinely incorporate core measures compliance along with their other duties, give hospitals greater value for money spent than hiring case managers just for core measure compliance.
Then there are problems with the core measures themselves, as a recent JAMA study shows. Fonarow and colleagues examined the correlation between heart failure-related 60- to 90-day mortality and re-hospitalizations and CMS core measures.1 They concluded that “current heart failure performance measures, aside from prescription of an ACE inhibitor or angiotensin receptor blocker at discharge, have little relationship to mortality and combined mortality/rehospitalizations … post-hospitalization.” The authors urge the adoption of additional measures and better methods for identifying and validating heart failure performance measures.
More to Come
Core measure weakness notwithstanding, Dr. Greeno believes CMS core measures represent a major salvo in the pay-for-performance movement. “They’re the first step in changing the entire reimbursement system,” he says. “To succeed, a hospital will need the right doctors trained to work together as a team, with consensus on order sets, care protocols, excellent communication with primary care physicians, and statistical identification of obstacles to achieving quality within the hospitals.” TH
Marlene Piturro is a regular contributor to The Hospitalist.
Reference
- Fonarow GC, Abraham WT, Albert NM, et al. Association between performance measures and clinical outcomes for patients hospitalized with heart failure. JAMA. 2007 Jan 3;297(1):61-70.