Acute Myocardial Infarction Measures
  • Quality: A composite score for AMI in each care setting could be formulated to determine whether patients had received all the care they should have received. Each measure could be equally weighted, and a straight average could be taken—one for HQA measures and one for AQA measures.

  • Resource use: To capture resource use, the committee proposes longitudinal measures (risk-adjusted mortality) and resource use (standardized costs for Medicare Parts A and B) for all patients at a given hospital with AMI.

  • Eligibility for rewards: The hospital and all physicians who billed above a minimum threshold number of E&M claims for the hospital’s AMI patients during the subsequent year would be eligible.

  • How to distribute: There are two choices: (1) rewards could go to hospitals for distribution; or (2) rewards could be split between hospitals (X percent) and physicians (100–X percent), with physician rewards being distributed in proportion to the share of E&M claims.

REWARDING HEALTH PLAN CARE

Background

Health plans have been reporting data for more than 10 years through the National Committee for Quality Assurance’s (NCQA) Health Plan Employer Data and Information Set (HEDIS). HEDIS, first released by the HMO Group in 1991 and revised by NCQA in 1993, measures the performance of health plans on member satisfaction and delivery of chronic and preventive care for the purpose of accreditation and certification. HEDIS is used by over 90 percent of managed care organizations in the United States. A subset of health plans that work with Medicare, called Medicare Advantage plans, are paid out of Medicare Part C.

  • Clinical quality: HEDIS measures are updated annually and are widely endorsed and used. They reflect the following aspects of care: effectiveness of care (preventive screenings; immunizations; treatment of heart attacks, depression, asthma), access/availability of care (access to primary health care and dentistry, timeliness of claims), satisfaction with the experience of care (surveys for adult and child care), health plan stability, use of service, cost of care, informed health care choices, and health plan descriptive information. These data are reported publicly as the quality data within Medicare’s Personal Plan Finder, a website dedicated to comparing Medicare health plans.



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