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Broker News | April 2015 | Vol. 10 No. 3
Broker News | April 2015 | Vol. 10 No. 3

Excellus BCBS Awards Hospitals $26 Million for Quality Improvements

Forty-five upstate New York hospitals and health centers last year earned $26 million in quality improvement incentive payments from us as part of our Hospital Performance Incentive Program (HPIP). In the past 10 years quality performance incentives from us have exceeded $197 million.

“We applaud our hospital partners' not only for their willingness to collaborate with our health plan on methods and measurements to improved health outcomes and patient safety, but also for tying those outcomes to a financial incentive to drive focus in mutually agreed upon quality goals,” said Carrie Whitcher, vice president clinical quality at Excellus BlueCross BlueShield.

Eight hospitals in the Finger Lakes Region participated in this program in 2014 including Clifton Springs Hospital, F.F. Thompson Hospital, Highland Hospital, Newark-Wayne Community Hospital, Nicholas H. Noyes Memorial Hospital, Rochester General Hospital, Strong Memorial Hospital and Unity Hospital.

“The Excellus BlueCross BlueShield Hospital Performance Incentive Program over the years has recognized Rochester General, Unity and Newark-Wayne Community Hospitals’ focus on improvement initiatives important to the care and outcomes of our patients,” said Cindy Bileschi, Sr. Director Clinical Regulatory Compliance, Rochester Regional Health System. “We appreciate the Excellus BCBS incentive program’s support of our strategic quality goals and the recognition of the creative and hard work of our clinicians that positively impacts the people in our community who come to us for care.”

Launched in 2004, the HPIP program evaluates participating hospitals on over 247 performance measures. In 2014, hospitals achieved 88 percent of all target quality levels. In addition to required clinical and patient safety measures, other nationally-endorsed measures and target outcomes are jointly agreed upon by each hospital and the health insurer using benchmarks established by the Centers for Medicare & Medicaid Services (CMS), The Joint Commission (TJC), the Institute for Healthcare Improvement (IHI), and others.

Areas targeted for improvement include:

  • Clinical Processes of Care – Focused on improvements in heart attack care, heart failure, pneumonia, and surgical care, and other measures that may be unique to each participating hospital
  • Patient Safety – Centered on reductions in hospital-acquired infections, falls, pressure ulcers, readmissions, and other adverse events or errors that affect patient care
  • Patient Satisfaction – Using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, which is the first national, standardized, publicly-reported survey of patients’ perspectives of hospital care

Relevance in upstate New York

In 2010, New York state reported about 108,000 hospital-acquired infections, including 24,000 in upstate New York, according to an Excellus BCBS fact sheet, Hospital Acquired Infections in Upstate New York (PDF). Those hospital-acquired infections led to an estimated 5,000 New York state deaths, 1,100 of which were in upstate New York.

If upstate New York hospitals could lower the number of hospital-acquired infections by even 20 or 40 percent, there would be an estimated 5,000 to 10,000 fewer infections and 200 to 400 associated deaths, the Excellus BCBS report concludes. That would also save upstate New York state hospitals an estimated $68 million to $137 million annually.


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