Core measures and "pay for quality

Dear Medical Staff Leader:

The Medicare Prescription Drug Improvement and Modernization Act of 2003 will bring "pay for quality" to the attention of every hospital and medical staff. As a result of the bill, hospitals that fail to submit data to the federal government about its performance on core measures will receive 0.4% less Medicare reimbursement than it would have received.

That percentage may not sound like much, but a hospital that typically receives $60 million in annual revenue from Medicare would lose $240,000 if it failed to report this performance data. That $240,000 goes straight to the facility's bottom line. Therefore, the bill will motivate every hospital that hasn't been submitting this data to do so by November 2004 when the provision goes into effect. The bill will also encourage governing board members and other hospital leaders to increase their focus on the core measures.

Core measures reflect evidence-based best practices that directly affect patient outcomes. A hospital's success with regard to these indicators depends on the care delivered by its medical staff. As a medical staff leader, you should lead an effort among your fellow physicians to improve your hospital's compliance with these best practices. That means ensuring all physicians are educated about the core measures. In addition, you must address any physician resistance to complying with these evidence-based best practices.

Work with hospital management to ensure standard order sets and other system improvements are put in place to improve compliance. Physician should also receive feedback on the hospital's performance on these measures and their personal performance so they have a chance to self-correct if necessary. The goal is to use the mandated core measures reporting to improve the quality of care delivered at your hospital.

That's all for this week.

All the best,

Rick Sheff, MD