Duke University Health System Recognized for High Quality Care

By Duke Medicine News and Communications

Duke University Health System received nearly $210,000 from the Centers for Medicare & Medicaid Services (CMS) in a project that rewards hospitals for high quality inpatient care.

Duke University Hospital was named a top performer in two clinical areas and received six monetary awards totaling $120,088, Duke Raleigh was named a top improver in three clinical areas and received seven monetary awards totaling $62,433, while Durham Regional Hospital received four attainment awards totaling $26,833.

“Duke’s ongoing commitment to quality and safety excellence is at the core of our central promise to patients to provide the very best in health care services,” says William J. Fulkerson, Jr, MD, executive vice president of Duke University Health System. “Succeeding in a project like this is also an important learning opportunity for us as value-based purchasing programs will be an important future component of the Affordable Care Act.”

The project, called the Hospital Quality Incentive Demonstration, was started six years ago by Premier health care alliance and the CMS to reward hospitals that are effective at improving the quality of inpatient care.

Approximately 225 hospitals across 36 states voluntarily provided data to Premier which tracks performance and measures improvement in six clinical areas: heart attack, coronary artery bypass graft (CABG), heart failure, pneumonia, hip and knee replacements, and surgical care.

More than 30 nationally defined, standardized, risk-adjusted measures representing process of care and patient outcomes are tracked to evaluate whether the care provided consistently meets or exceeds accepted evidence-based practice standards. Examples of the measures include the proper administering of aspirin, beta blockers and antibiotics, and readmission and mortality rates.

What would you do? Should University Health and Community Health join forces?

The Problem

Community Health and University Health are two healthcare organizations in a state that has recently seen the continued growth and rising market power of a large health system, as well as physician and insurer changes and challenges. Both organizations have been financially healthy, but downturns in the past three months suggest that the good times may be at an end.

The Situation

Like many other markets, the state in this scenario has experienced widespread consolidation of providers over the past 10 years. One system, in particular, based in the largest metropolitan area in the state, has been especially aggressive in functioning as a consolidator. This system has captured a 45 percent share of the metro market (population of 1.5 million), is a significant presence throughout the southern and most populous half of the state, and now has about 15 percent to 20 percent of that market, too.

The provider landscape has changed dramatically in this metropolitan area. As a result of closures and consolidations, only one independent hospital (Children’s) remains where there had previously been 20. In addition to the large system (which comprises five hospitals), the four other players, all of which operate essentially exclusively in the metro area, are:

* Community Health with three hospitals and a 13 percent share

* University Health with two hospitals and a 12 percent share

* Catholic Health with four hospitals and a 17 percent share