The finding that 30-day mortality rates for acute MI, heart failure and pneumonia predict overall quality, at least in terms of mortality, may come as a relief. Or it may mean grief for some hospitals.
This week, Marta L. McCrum, MD, of Harvard School of Public Health in Boston, and colleagues reported in JAMA Internal Medicine that hospitals with low mortality rates for those three conditions were more likely to be top performers for overall mortality. Their motivation for exploring the topic was a looming move by the Centers for Medicare & Medicaid Services (CMS) to begin using the three quality measures to calculate payments under its hospital inpatient value-based purchasing program.
CMS made 30-day mortality for the three conditions an outcome measure for fiscal year 2014.
They also looked at traditional markers of quality: hospital size, as a surrogate for volume, and being a teaching hospital. Both were weaker predictors of top performance than the three aggregate conditions.
That is not the only change in store for 2014. The ratcheting up of penalties for hospitals with higher-than-expected 30-day readmission rates also will go into effect soon. The 1 percent withholding in Medicare reimbursement will jump to 2 percent for fiscal year 2014. While some hospitals may have been willing to accept a 1 percent cut, a 2 percent bite is expected to get their attention.
McCrum et al considered reasons for the correlation between mortality rates for the three conditions and overall mortality rates. They proposed uniform procedures or leadership and a culture that encourages quality may be factors, and suggested that “broader findings from our work support the notion that there may actually be ‘good’ and ‘bad’ hospitals and that performance on a manageable set of key indicators can help identify such institutions.”
As the fiscal vice from the readmissions penalties tightens, some policy observers worry that already resource-strapped hospitals will fall into a tailspin. Could the same hold true under value-based purchasing? I guess we will see.
On another note, a happy Fourth of July to those who wave the stars and stripes. Cardiovascular Business will take a break for the week and will resume newsletters on July 8.
Cardiovascular Business, editor