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Hospital Cardiovascular Outcome Measures in Federal Pay-for-Reporting and Pay-for-Performance Programs: A Brief Overview of Current Efforts

In recent years, the Centers for Medicare & Medicaid Services (CMS) has expanded its array of hospital quality measures in cardiovascular disease. In doing so, CMS has shifted its focus from process measures to outcome measures, increasingly using the measures in pay-for-reporting and performance programs.1 The emerging measures and their association with policy initiatives have changed over time and may be difficult to track for the casual observer, even as they increasingly influence payments to individuals and institutions.

This Perspective provides a primer on the CMS hospital cardiovascular outcome measures included in the Hospital Inpatient Quality Reporting Program (IQR), Hospital Readmissions Reduction Program (HRRP); and Hospital Value-Based Purchasing (HVBP) Program. We begin with a brief background on past and current CMS quality measurement efforts and then provide an overview of measure specifications for the current cardiovascular outcome measures used in these programs. We then summarize how the measures are currently used in the IQR, HRRP, and HVBP to assess hospital performance.

CMS has a history of quality measurement dating back to its implementation of the Medicare Utilization and Quality Control Peer Review Program in the early 1980s. Initially, the Peer Review Program conducted implicit reviews of select cases, as suggested to them via beneficiaries, providers, or sampling in order to determine if appropriate care was provided. Over time, CMS reorganized the Peer Review Program into Quality Improvement Organizations, which, in addition to their quality improvement objectives, were charged with systematically gathering and reviewing data for the purpose of quality measurement.2,3 Concerns were raised surrounding the voluntary nature of participation in Quality Improvement Organization measurement activities and the potential for bias toward high-performing hospitals, which would be more likely to participate.4

Partially in response to these concerns, CMS shifted its quality measurement activities away from individual …