The stated value of the MIPS is to incentivize providers, including APRNs, to practice by providing measurable high‐quality care that is also cost efficient. One of the criticisms of the program has been that it allows providers to choose measures that best reflect the patients served in that provider’s practice. While this makes sense in terms of each individual provider, there is such a wide array of options that it is difficult to aggregate data that will evaluate all providers on similar measures, thus making it difficult to ascertain the relative quality and cost savings.
Partnership for Patients
Partnership for Patients is a national partnership initiated in 2011 by HHS that was projected to save 60,000 lives by preventing injuries and complications in patient care over three years. HHS stated upon its inception that the Partnership for Patients also had the potential to save up to $35 billion in health care costs, including up to $10 billion for Medicare. At that time it was estimated that over 10 years, the Partnership for Patients could reduce costs to Medicare by $50 billion and save billions more in Medicaid. More than 3,500 hospitals, physician and nurse groups, consumer groups, and employers pledged their commitment to the Partnership for Patients. Oversight for this program has been under CMS’s Center for Medicare and Medicaid Innovations.
The partnership asked hospitals to focus on nine types of medical errors and complications where the potential for dramatic reductions in harm rates has been demonstrated by pioneering hospitals and systems across the country. Examples included preventing adverse drug reactions, pressure ulcers, childbirth complications, and surgical site infections. The CMS Innovation Center pledged to help hospitals adapt effective, evidence‐based care improvements to target preventable patient injuries on a local level, developing innovative approaches to spreading and sharing strategies among public and private partners in all states. Members of the partnership were to identify specific steps they will take to reduce preventable injuries and complications in patient care.
The Partnership for Patients, a public–private partnership, was invested in reforms that help achieve two shared goals:
Keeping hospital patients from getting injured or sicker. Achieving this goal meant approximately 1.8 million fewer injuries to patients, with more than 60,000 lives saved from 2010 to 2013. From 2014 to 2017, hospital‐acquired conditions (HACs) fell by 13%, saving about 20,700 lives and about $7.7 billion in health care costs.
Helping patients heal without complication. By the end of 2013, preventable complications during a transition from one care setting to another were expected to decrease so that all hospital readmissions would be reduced by 20% compared with those of 2010. Achieving this goal meant that more than 1.6 million patients recovered from illness without suffering a preventable complication requiring rehospitalization within 30 days of discharge. Similar outcomes were reported for 2017, the last year of reporting.
How has the Partnership for Patients done so far in meeting these goals? As reported by Blumenthal Abrams, and Nuzum (2015), 30‐day readmission rates for Medicare enrollees declined nationally from more than 19% to less than 18.5% in 2012 and to 17.5% in 2013; this is equivalent to 150,000 fewer readmissions between January 2012 and December 2013. The first ever decline in hospital composite rates of HACs nationally decreased from 2010 to 2013. It is estimated that this prevented roughly 50,000 deaths and saved $12 billion. The overall 9% decline in the incidence of HACs from 2010 to 2012 includes 560,000 fewer HACs in just two years, with the prevention of 15,000 deaths due to reductions in adverse events, falls, and infections, and a saving of $3.2 billion in 2012 alone. In addition, through the end of 2013, falls and trauma decreased by nearly 15%, pressure ulcers decreased by 25%, ventilator‐associated pneumonias decreased by over 50%, and venous blood clotting complications decreased by 13%.
While currently the goals for this initiative remain essentially unchanged, the Partnership for Patients has shifted its aims to engaging 100% of the nation's acute care medical centers participating in making hospital care safer, more reliable, and less costly through the achievement of two goals. The first goal, to make care safer through keeping patients from getting injured or sicker, is to decrease all‐cause patient harm (to 97 HACs/1,000 discharges) by 20% percent compared to the 2014 interim baseline (of 121 HACs/1,000 patient discharges).
The second goal, to improve care transitions by helping patients heal without complications, is now defined as decreasing preventable complications during a transition from one care setting to another, so that all 30‐day hospital readmissions would be reduced by 12% as a population‐based measure (readmissions per 1,000 people) (https://innovation.cms.gov/innovation‐models/partnership‐for‐patients).
In 2016 CMS awarded contracts to 16 Hospital Improvement Innovation Networks (HIINs) as a part of the integration of the Partnership for Patients Hospital Engagement Networks (HENs) into the Quality Improvement Network–Quality Improvement Organization (QIN‐QIO) program to prepare for the continuation of the Partnership for Patients. The HIINs built upon the collective momentum of the Partnership for Patient’s HENs and QIO to reduce patient harm and readmissions. The HIINs also represent the integration of the work previously done by the HENs in support of the QIO and quality improvement efforts for the Medicare population.
As a second effort, the Partnership for Patients network has since included 46 sites that received awards for their participation in the Community‐based Care Transitions Program. These community efforts to build collaborations include community‐based organizations such as social service providers or Area Agencies on Aging, multiple hospital partners, nursing homes, home health agencies, pharmacies, primary care practices, and other types of health and social service providers serving patients within each community. These were designed to also serve as a way to test different models for improving care transitions for Medicare beneficiaries (https://downloads.cms.gov/files/cmmi/cctp‐final‐eval‐rpt.pdf).
National Quality Strategy Is the Future
In compliance with ACA, the National Quality Strategy was released via a report to Congress in 2011. Consistent with the initiatives of the National Quality Forum and the National Priorities Partners Goals and Priorities, the National Quality Strategy pursued three broad aims—similar to those referenced by the Institute for Health Care Improvement as the Triple Aims—to guide and assess local, state, and national efforts to improve the quality of health care. Subsequently, a fourth aim was added to improve the experience of providing care.
The aims included the following:
Better care. Improve the overall quality by making health care more patient centered, reliable, accessible, and safe.
Healthy people/healthy communities. Improve the health of the US population by supporting proven interventions to address behavioral, social, and environmental determinants of health in addition to delivering higher‐quality care.
Affordable care. Reduce the cost of quality health care for individuals, families, employers, and government.
Attaining joy and meaning in the work of health care staff for providers, clinicians, and staff.
The National Quality Strategy was based on the recognition that in the end, all health care is local, and its intent has been to help ensure that these local efforts remain consistent with shared national aims and priorities. The Secretary of HHS developed this initial strategy and plan through a participatory, transparent, and collaborative process that reached out to more than 300 groups, organizations, and individuals who provided comments. The Agency for Healthcare Research and Quality (AHRQ) was tasked with supporting and coordinating
