Novel Approach to Improving Cardiovascular Care

To Advance Heart Care Treatment, Physician Program at Montefiore Will
Measure Everything from Aspirin and Beta Blockers to Patient Satisfaction


NEW YORK, Oct. 6 - Thousands of heart patients in the Greater New York region will receive top quality, comprehensive cardiac care in an innovative cardiovascular program in which physicians at a major academic medical center will receive incentive payments based on 60 performance measures for outpatient and inpatient care.

The program is one of many pioneering initiatives at Montefiore Medical
Center's nationally recognized Montefiore-Einstein Heart Center and will
challenge physicians to score well on a mix of measurable activities that
indicate quality care for patients, such as: is the patient enrolled in a
smoking cessation program; has beta blocker therapy been persistent; is
blood pressure under control; and, was the patient generally satisfied with
his care? The program is for heart patients and for patients with risk
factors for heart disease, such as diabetes, hypertension,
hypercholesterolemia, smoking and obesity.

Montefiore is the only hospital in New York State to initiate such a
pay- for-performance program, which is being funded by a $2.4 million grant
from the New York State Health Department.

"Cardiovascular care has advanced considerably over the past decades
through prevention programs, clinical drug trials and advancements in
surgery such as robotics," said Steven M. Safyer, MD, Senior Vice President
and Chief Medical Officer, Montefiore. "This state grant supports
Montefiore's continuing focus on innovations in cardiovascular treatment by
adding a new approach. It gives us the opportunity to look at the physician
side of the equation and to implement a model pay-for-performance cardiac
care program."

Here's how the pay-for-performance project will work in an outpatient
setting for one group of patients -- those who are at-risk for heart
disease. If a physician in one of Montefiore's ambulatory care centers
meets certain clinical performance standards for her patients (such as
controlling high blood pressure, checking weight, providing nutrition
counseling, checking smoking status, and giving a flu vaccine), she could
earn an income bonus. The higher her score is on the list of performance
standards that are recorded electronically, the larger the bonus -- up to a
certain maximum. The same type of financial incentives, with different
performance criteria, would apply to treating patients with existing heart
disease or diabetes.

"This approach aligns the incentives for patient, physician and
hospital in order to promote best practices and optimal outcomes," said
Safyer.
Montefiore will use its unique clinical information system to quantify
performance.
In the more complex environment of an inpatient hospital setting,
performance measurements will go beyond clinical data to include the number
of readmissions for heart care patients within a year's time and patient
satisfaction survey scores.
"This project breaks new ground," said Rohit Bhalla, MD, Chief Quality
Officer at Montefiore. "Most pay-for-performance experiments are conducted
by insurers, not providers. Providers generally do not have an incentive to
reduce utilization."
"Montefiore is uniquely positioned for this grant," said Stephen
Rosenthal, president of Montefiore's CMO, the Care Management Company. "We
have a pioneering care coordinating program (Care Guidancesm) for 150,000
Bronx patients for whom we are not only the provider, but also act as an
insurer. Therefore, we have an alignment of all the right incentives to
improve quality and optimize appropriate utilization for these patients.
Most hospitals have not adopted at-risk arrangements such as this, which
has very similar incentives to the pay-for-performance model."
Unique aspects of the Montefiore pay-for-performance grant:

-- It is highly unusual for a hospital to be in such a program.
-- Montefiore is partnering with the state and insurers to create an
incentive pool of monies.
-- Montefiore can measure performance standards across an integrated
system of care -- in an inpatient hospital setting and throughout its
many medical group outpatient settings.
-- It is "payer neutral" because the physician will see only one set of
criteria for incentive pay. Currently, each insurer has its own
separate set of performance standards, which is confusing for the
physician.
-- Pay-for-performance measurements will extend beyond just clinical
standards, and include patient satisfaction surveys and utilization
rates.
-- Montefiore is using a highly sophisticated, existing clinical
information system to measure both the performance standards required
by the state and an additional dozen standards of care added by
Montefiore.
Montefiore Medical Center, The University Hospital and Academic Medical
Center for the Albert Einstein College of Medicine, encompasses 125 years
of innovative medical "firsts," pioneering clinical research, dedicated
community service and ground-breaking social activism.

A full-service, integrated delivery system caring for patients from New
York, Westchester County and beyond, Montefiore is a 1,122-bed medical
center that includes three hospitals: the Henry and Lucy Moses Division,
the Jack D. Weiler Hospital and The Children's Hospital at Montefiore; a
large home healthcare agency; the first and largest school health program
in the U.S.; a 21-site medical group practice integrated throughout the
Bronx and Westchester; and a care management organization providing
services to 179,000 health plan members. The medical center is ranked by the prestigious Leapfrog Group among the top one percent of all U.S. hospitals based on its strategic investments in sophisticated and integrated healthcare technology.
Montefiore's distinguished centers of excellence include cardiology and
cardiac surgery, cancer care, tissue and organ transplantation, children's
health, women's health, obesity, diabetes, surgery and the surgical
subspecialties. Montefiore is a leader in the treatment of headaches, cough
and sleep disorders, geriatrics and geriatric psychiatry, neurology and
neurosurgery, bioethics, adolescent and family medicine, HIV/AIDS and
social medicine, among many other specialties. (PRN)