Measures & money

Quality measures can be sticks or carrots. Either way, they may influence physicians’ behaviors and hospitals’ practices, so watching what is on the horizon is important. Two recent analyses could change the playing field for providers who provide CABG surgery or who wrestle with hospital-acquired complications.

CABG is slated to be added to the readmissions reduction initiative of the Centers for Medicare & Medicaid Services. CMS already penalizes hospitals with lower than expected 30-day readmissions for acute MI, heart failure and pneumonia. The goal is to improve quality and lower cost, but metrics for meting out withholding of payment have come under criticism. Measures based on administrative data cannot capture clinical factors and may not properly adjust for them.

CMS is still formulating its approach for CABG, so there may be an opportunity to refine the methodology for CABG readmissions. David Shahian, MD, of Massachusetts General Hospital in Boston, and colleagues propose that the Society of Thoracic Surgeons Adult Cardiac Surgery Database (STS-ACSD) may be just the ticket. The database already is used to provide risk-adjusted feedback reports to 1,050 cardiac programs that perform CABG surgery in the U.S.

They developed an all-cause readmission measure using the database. By linking Medicare data and STS-ACSD data, they demonstrated their measure exceeded the performance of CMS-based approaches. CMS was a collaborator in the study, so this finding likely will carry weight in measure development.

CMS also is focusing on avoidable complications that occur while patients are in the hospital. The analytics company Premier considers some of the conditions targeted by CMS to be too narrow, occurring too infrequently to have a significant impact on quality and cost.

The company created an alternative methodology that includes mortality, length of stay, cost and to some degree reimbursement. Ultimately, Premier wants its methodology to be used for future quality measures.

Based on its analysis, acute MI was one of the 10 top potential inpatient complications. The analysts determined that acute MI complications cost $110 million in 2013. Their next mission is to tease out what is avoidable and unavoidable and identify opportunities to prevent harmful events.

Neither the CAGB nor the complications approaches have yielded measures, but if they do, they will impact care and a hospital’s bottom line. We’ll be watching.

Candace Stuart

Cardiovascular Business, editor