Hospitals Medicaid/Medicare

Paying for Quality

The Wall Street Journal reports:

“…research showing that the majority of U.S. spending also highly concentrated on a small group of high-cost patients. These typically include people with one or more chronic conditions, such as diabetes, high cholesterol, arthritis and cancer, said Steven B. Cohen, a director at the federal Agency for Healthcare Research and Quality.

The majority of that spending is unavoidable, but research shows a large portion isn’t. Of the $2.5 trillion the U.S. spent on health care in 2009, $765 billion was waste, according to a study by the Institute of Medicine, an independent body that advises the federal government on health policy. That includes $210 billion on unnecessary services.”

What is Medicare doing about these problems?

“Under the 2010 health overhaul law, the agency is giving health-care providers incentives to band together and coordinate care for groups of patients. If their costs fall by a great enough percentage, the providers get to pocket some of the savings. Another part of the law will allow Medicare to impose financial penalties on hospitals that readmit high numbers of patients within 30 days of discharge.”

Medicare is making efforts to reduce payments to high cost, low cost providers and increase payments to low cost, high quality providers.  The issue is, are the quality measures specific enough?  Patients do not care about ‘overall’ quality, they care about the quality for treating their specific disease.  Readmission rates are just one measure of quality.  Although Medicare uses a number of other quality measures covering patients suffering from prevalent conditions, many patients still do not have quality measures for their specific disease.  CMS could increase the number of quality numbers measured, but this would impose an administrative burden on hospitals to report all these measures.

To all my physician readers: are there too many quality measures or not enough?

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