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Performance Measures

On July 1, 2011, performance on clinical quality and patient experience measures began directly impacting the bottom line of hospitals across the country through Medicare's Hospital Inpatient Value-Based Purchasing (HVBP) Program.

The HVBP Program measures in FY 2013 focus on how closely hospitals follow best clinical practices and how well hospitals enhance patients' experiences of care. In the future, CMS plans to add additional outcomes measures that focus on improved patient outcomes and prevention of hospital-acquired conditions. Measures that have reached very high compliance scores would likely be replaced, continuing to raise the quality bar.

The measures for FY 2013 have been endorsed by national bodies of experts, including the National Quality Forum. All measures adopted for use in the HVBP Program are also included on Hospital Compare.


Hospital Value-Based Purchasing: Measure Explanations

Measure Title

Brief Explanation

Clinical Process of Care Domains - weighted 70%

AMI-7a: Percent of Heart Attack Patients Given Fibrinolytic Medication Within 30 Minutes Of Arrival

Blood clots can cause heart attacks. Doctors may give this medicine, or perform a procedure to open the blockage, and in some cases, may do both.

AMI-8: Percent of Heart Attack Patients Given PCI Within 90 Minutes Of Arrival

The procedures called Percutaneous Coronary Interventions (PCI) are among those that are the most effective for opening blocked blood vessels that cause heart attacks. Doctors may perform PCI, or give medicine to open the blockage, and in some cases, may do both.

HF-1: Percent of Heart Failure Patients Given Discharge Instructions

The staff at the hospital should provide you with information to help you manage your heart failure symptoms when you are discharged.

PN-3b: Percent of Pneumonia Patients Whose Initial Emergency Room Blood Culture Was Performed Prior To The Administration Of The First Hospital Dose Of Antibiotics

A blood culture tells what kind of medicine will work best to treat your pneumonia.

PN-6: Initial Antibiotic Selection for CAP in Immunocompetent Patient

Antibiotics are medicines that treat infection, and each one is different. Hospitals should choose the antibiotics that best treat the infection type for each pneumonia patient.

SCIP-Inf-1: Prophylactic Antibiotic Received Within One Hour Prior to Surgical Incision

Getting an antibiotic within one hour before surgery reduces the risk of wound infections. This measure shows how often hospital staff make sure surgery patients get antibiotics at the right time.

SCIP-Inf-2: Prophylactic Antibiotic Selection for Surgical Patients

Some antibiotics work better than others to prevent wound infections for certain types of surgery. This measure shows how often hospital staff make sure patients get the right kind of preventive antibiotic medication for their surgery.

SCIP-inf-3: Prophylactic Antibiotics Discontinued Within 24 Hours After Surgery End Time

Taking preventive antibiotics for more than 24 hours after routine surgery is usually not necessary. This measure shows how often hospitals stopped giving antibiotics to surgery patients when they were no longer needed to prevent surgical infection.

SCIP-Inf-4: Cardiac Surgery Patients with Controlled 6AM Postoperative Serum Glucose

All heart surgery patients get their blood sugar checked after surgery. Any patient who has high blood sugar after heart surgery has a greater chance of getting an infection. This measure tells how often the blood sugar of heart surgery patients was kept under good control in the days right after their surgery.

SCIP-Card-2: Surgery Patients on a Beta Blocker Prior to Arrival That Received a Beta Blocker During the Perioperative Period

Many people who have heart problems or are at risk for heart problems take drugs called beta blockers to reduce the risk of future heart problems. This measure shows whether surgery patients who were already taking beta blockers before coming to the hospital were given beta blockers during the time period just before and after their surgery.

SCIP-VTE-1: Surgery Patients with Recommended Venous Thromboembolism Prophylaxis Ordered

Certain types of surgery can increase patients' risk of having blood clots after surgery. For these types of surgery, this measure tells how often treatment to help prevent blood clots was ordered by the doctor.

SCIP-VTE-2: Surgery Patients Who Received Appropriate Venous Thromboembolism Prophylaxis Within 24 Hours Prior to Surgery to 24 Hours After Surgery

This measure tells how often patients having certain types of surgery received treatment to prevent blood clots in the period from 24 hours before surgery to 24 hours after surgery.

Hospital Consumer Assessment of Healthcare Providers and Systems(HCAHPS survey) - weighted 30%

Patient Experience of Care

A random sample of patients discharged from hospitals across the country are surveyed and asked questions about their feelings and perceptions about their hospital stay. This measure combines hospital performance on questions that asked patients their levels of satisfaction with some of the following elements of their stay:

  • How well nurses communicated with patients
  • How well doctors communicated with patients
  • How responsive hospital staff were to patients' needs
  • How well caregivers managed patients' pain
  • How well caregivers explained patients' medications to them
  • How clean and quiet the hospital was
  • How well caregivers explained the steps patients and families need to take to care for themselves outside of the hospital (i.e., discharge instructions)

The survey also asks patients to give an overall satisfaction rating to their hospital stay.

 

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