Individual hospital improvements are striking. Fifteen hospitals moved from "worst to first" rankings, moving from the bottom to the top fifth of hospitals in one or more clinical areas. These hospitals improved by an average 32.6 percentage points in quality scores over three years.

"Persistent deficiencies in the level of quality of care delivered in the U.S. health care system demand focus and attention by all," said Weems. "This demonstration and the leadership exhibited by Premier show us the way forward, and we are eager to work with Congress, the health care community and representatives from patient organizations to move forward to bring these new innovations to every American. It is time to move forward and reward and encourage reliable, high quality care in all parts of Medicare."


The quality measures were developed by government and private organizations, such as the National Quality Forum, the American Hospital Association and the Leapfrog Group. In addition, they have been tested by CMS, the Joint Commission on Accreditation of Healthcare Organizations and the Agency for Health Research Quality (for more information on the measures, go to: www.qualitydemo.com).

The average composite quality scores (CQS), an aggregate of all quality measures within each clinical area, improved significantly between the inception of the program and the end of Year 3 (2006):

-From 87 percent to 96 percent for patients with AMI (heart attack)
-From 85 percent to 97 percent for patients with coronary artery bypass graft.
-From 64 percent to 89 percent for patients with heart failure.
-From 69 percent to 90 percent for patients with pneumonia.
-From 85 percent to 97 percent for patients with hip and knee replacement.

The total increment in average CQS over HQID's first three years is 15.8 percentage points. Between HQID's second and third years, the average CQS increase is 4.4 percentage points.

The top-performing 112 hospitals earned a total of $7.0 million in incentive payments for substantial and continual advancement in quality of care. For the third year of HQID, Sacred Heart Medical Center, in Spokane, WA, received the highest quality incentive payment of $385,342 for achieving top performance in four of the five clinical areas.

CMS has awarded more than $24.5 million over the first three years of the project. The HQID project was extended by CMS for an additional three years through September 2009.

For complete information about the HQID project and to view a list of those hospitals ranking in the top 50 percent in each focus area, visit www.cms.hhs.gov/HospitalQualityInits.

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