Aurora Health Care - Milwaukee, Wisconsin

Hospital Quality Incentive Demonstration

Overview: Aurora Health Care is a not-for-profit integrated health care provider with sites in more than 90 communities throughout eastern Wisconsin, including 13 hospitals, more than 100 clinics, and more than 115 community pharmacies.  Aurora was named one of the top-performing health systems in the country in a national Centers for Medicare & Medicaid Services (CMS), Premier healthcare alliance pay-for-performance project.  Launched in 2003, the Hospital Quality Incentive Demonstration (HQID) project was the first national project of its kind, designed to determine if economic incentives to hospitals and transparency of quality outcomes are effective at improving the quality of inpatient care.  Through the project, Premier collects a set of more than 30 evidence-based clinical quality measures from more than 250 hospitals across the country.  HQID tracks process and outcome measures in five clinical areas:

  • Acute myocardial infarction (AMI)
  • Heart failure
  • Coronary artery bypass graft (CABG)
  • Pneumonia
  • Hip and knee replacement

These measures are evidence-based best practice.  Each participating hospital regularly submits its data on each of these measures.  The goal is to raise the quality care for patients in all participating hospitals.  Aurora's goal was to reach the top level of performance in all the measures.

At the start of the HQID project, Aurora was in the 50th percentile or below in the five clinical areas being measured.  Its performance improvement started with the culture ingrained by the system's chief executive officer, who introduced a "flawless implementation" program to support care management goals.  Using this approach, one person in each facility was made accountable for the "pursuit of perfection" as opposed to "quality improvement."  This care management team documented plans for each focus area, including measurement systems.  For example, Web-based dashboards were created to enable easy access to all data, and report cards were developed to enable quick response.  A reactor panel was established to review and critique 90-day action plans.  After each action in the five clinical areas was put in place, debriefings were held to evaluate initial results.  Based on findings, action plans were adjusted to address key areas.

Impact: At HQID hospitals, the average Composite Quality Score (CQS), an aggregate of all quality measures within each clinical area, improved by 4.4 percent between the project's second and third year for total gains of 15.8 percent over the project's first three years.  Aurora Health Care has been one of the top-performing health care systems since the HQID project's inception.  In the Year 3 results, Aurora hospitals excelled in several of the quality areas:

  • Aurora's hospitals are top performers in 40 of the 47 quality areas that are measured.  This is the most of any system.
  • Aurora hospitals received incentive payments in 24 quality areas, the most of any system in the country.
  • Ten of the Aurora hospitals that have been a part of the quality effort are in the top for care of people with pneumonia.

Length-of-stay and readmission rates improved across the board.  All of these improvements have been made using existing resources and without hiring additional personnel.

Challenges/success factors: By promoting a collaborative, inclusive environment among the 10 Aurora facilities involved in the project, Aurora leaders have seen a friendly, healthy competition arise within the system.  This has energized employees and encouraged teamwork.

Future direction/sustainability: Aurora continues to use flawless implementation through all of its quality efforts.  This includes additional activities within the medical centers and focused activities for medical groups and home health.  Aurora continues to expand its efforts in clinical improvement and patient safety.

Aurora also is participating in the three-year extension of the project.  During the first three years of the demonstration, only top-performing hospitals were eligible for incentive payments.  The three-year extension will test the effectiveness of two new models as well:

  • Hospitals achieving a defined level of quality, or a quality threshold
  • Hospitals making the most improvement in quality that also achieve the quality threshold

The project will continue to track hospital performance in the clinical areas of pneumonia, heart bypass, heart attack (acute myocardial infarction), heart failure, and hip and knee replacement.  The extended demonstration includes the flexibility to add quality measures and clinical conditions in the fifth and sixth years.  New mortality and patient safety measures are among those that may be included.

Advice to others: Make sure you understand your data-what is captured, how it's captured, and how it's reported.  You can't measure what you don't document.  And make sure to hold debriefings during any improvement process to determine what worked, what didn't work, and why.  This way, it's easier to get back on track and realize results.

Contact: Patrick Falvey, PhD
Senior Vice President/Chief Integration Officer
Telephone: (414) 647-3124


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