Production and Implementation of the CMS Hospital Outcomes and Efficiency Measures

Patients and consumers need accurate and timely information to make decisions about their health care. Those receiving high quality care during and after hospitalization are likely to have better outcomes, such as survival, functional ability, and quality of life. Beginning in 2009, the Centers for Medicare & Medicaid Services (CMS) embarked on a strategy to assess a broad range of health care activities that affect patients’ well-being and make that information publicly available, to help improve health care quality and decision making.

To help improve consumer understanding of hospital quality, we implemented measures based on mortality and readmissions for:

• Acute myocardial infarction
• Heart failure
• Pneumonia
• Hip and knee replacements
• Stroke
• Chronic obstructive pulmonary disease

The risk-adjusted 30-day measures are based on Medicare claims and enrollment data for all hospitals in the country.

Our work also included producing measures of patient safety and inpatient quality based on indicators developed by the Agency for Healthcare Research and Quality as well as hospital-acquired conditions. We are also helping CMS implement measures for coronary artery bypass graft surgery and payment measures. In addition, we support CMS in implementing these measures in its pay-for-performance programs, including Hospital Value-Based Purchasing, Hospital Readmission Reduction Program, and the Hospital-Acquired Condition Reduction Program.