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Nurses who work in facilities that are participating in the Medicare demonstration project, such as Esiah Gibson, RN, of Methodist Dallas Medical Center, have been given greater responsibility to carry out quality-tracking measures.

When two Texas hospitals joined the Medicare pay-for-performance project, Virginia Davis, RN, MSN, vice president of quality for the facilities, saw a chance to improve patient care.

Now, nurses are telling her the quality initiative also is improving their role as patient advocates.

The Methodist Health System’s Dallas and Charlton medical centers are among 278 hospitals participating in a three-year demonstration project sponsored by the Centers for Medicare & Medicaid Services. Launched last year, the project aims to standardize hospital quality measurements and inspire patient care improvements. It also is testing whether financial incentives have an effect on patient care.

Hospitals that perform well in the demonstration project will earn Medicare reimbursement bonuses. Those that don’t improve will face reduced Medicare payments. Also, each hospital’s performance data will be posted on the CMS website for public scrutiny.

The hospitals want to deliver the best care, Davis said, and having measurable standards helps nurses achieve that goal.

“They can be stronger patient advocates,” Davis said. “It really empowers them to make it happen with the team.”

On the right track

The Premier Hospital Quality Incentive Demonstration Project, as it is called, is part of the care improvement initiative that the U.S. Department of Health and Human Services launched in 2001. The overall goal is to hold hospitals responsible for improving inpatient care for Medicare beneficiaries.

Voluntary participation in the pay-for-performance project was open to hospitals that use the Premier Inc. online database to track quality performance. About 1,500 nonprofit hospitals nationwide belong to the Premier purchasing group and 500 hospitals use the database.

The Medicare demonstration project tracks five clinical conditions prevalent among its recipients: acute myocardial infarction, coronary artery bypass grafts, heart failure, community-acquired pneumonia, and hip and knee replacements.

For each condition, hospitals are collecting data on standardized specific measures — a total of 34 for all five conditions.

For example, for pneumonia patients the hospitals track:

> The percentage of patients who received an oxygenation assessment within 24 hours before or after hospital arrival.
> Initial antibiotic consistent with current recommendations.
> Blood culture collected before first antibiotic administration.
> Influenza screening/vaccination.
> Pneumococcal screening/vaccination.
> Percentage of pneumonia patients who received first dose of antibiotics within four hours after hospital arrival.
> Smoking cessation advice/counseling.

Hospitals that score in the top 10% will receive an additional 2% of their Medicare reimbursement for the measured condition. Those in the second 10% will receive a 1% bonus. Conversely, in the third year, hospitals in the lowest 10% will have a 2% reduction, and those who score in the second-lowest 10% will see a 1% cut in reimbursement. Hospitals have the option of quitting the project at the end of the second year. All hospitals that rank in the top 50% will receive public recognition for their efforts, even if they don’t qualify for the financial rewards.