Bill links Medicare payments to quality measurements

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Congressman Altmire testifying before the House Ways and Means Committee. Image Source:

Rep. Jason Altmire, D-Pa., has introduced the Quality FIRST Act (H.R. 1776), a bill to provide for a program of quality measurement and reporting and for the use of performance-based payment within Medicare for inpatient services.

The legislation would require the Health and Human Services (HHS) secretary "to select appropriate evidence-based and statistically valid quality measures of care furnished by hospitals in inpatient settings for evaluating hospital performance."

It also would "require a utilization and quality control peer review organization to give priority of quality improvement assistance to low-performing hospitals." The measures that would be covered under the Quality First Act include heart attacks, heart failure, pneumonia and surgical infections.

The bill would provide incentives for high performers to continue their excellent performance, and for all hospitals to adopt more quality improvements, according to the American Hospital Association (AHA), which has come out in support of the bill. It would use quality measures that are evidence- and consensus-based, statistically valid, and developed in an open and transparent process. The measures would include only those endorsed by the National Quality Forum (NQF), and recommended by the Hospital Quality Alliance (HQA).

H.R 1776 ultimately calls for 2 percent of all inpatient payments to be diverted to make up the payment incentive pool. However, the AHA said it believes that a 1 percent pool would be a more appropriate size, at least until the consequences of the program for hospitals, both intended and unintended, can be determined.