I have spilled much ink on this blog discussing the pros and cons of pay-for-performance approaches to medicine. Incentivizing high quality care is good in theory, but in practice changes in quality have been modest and providers may be able to readily game the system. Despite these challenges, Medicare announced this week that it would being tying 30 percent of “traditional, or fee-for-service Medicare payments to quality or value through alternative payment models, such as Accountable Care Organizations (ACOs) or bundled payment arrangements by the end of 2016.”
To measure value, you need to be able to measure both cost and quality. Cost is easy to measure but quality not so much. The WSJ reports that “On Friday, the National Quality Forum, a nonprofit advisory group, submitted recommendations on 199 performance measures for Health and Human Services to consider in 20 federal programs.”
Many doctors are skeptical of administrative quality measures.
…there is little agreement on what measures matter most or are more likely to produce good value. “In many areas of patient care, we do not yet have high-quality outcome measures with enough specificity to drive improvement,” American Medical Association Executive Director James L. Madara wrote in a letter to the quality forum earlier this month.
Some doctors complain that whether patients get better is often out of their control; that outcomes measures take more work, not less; and that being held accountable for outcomes could prompt doctors to avoid treating the sickest patients.
More details on the announcement are available at this NEJM article.