The Quest to Improve Health Care Quality

By 2018, CMS aims to tie 90% of reimbursements to value-based care. Value-based reimbursement is the latest rage. According to a paper by Levine and co-authors in JAMA Internal Medicine, however, progress on quality of care has been modest at best.

Despite more than a decade of efforts to improve the quality of health care in the United States, the quality of outpatient care delivered to adults has not consistently improved

Why is this the case? A commentary by McGlynn, Adams, and Kerr gives one interesting perspective:

Much of the work in quality improvement has focused on approaches that are driven by payers and policy makers. These have included measurement and public reporting, payment incentives, investments in electronic medical records, and developing virtual systems of care in select areas. None of these approaches by itself is likely to fundamentally alter the level of quality delivered throughout the nation. To do so requires significant work by health professionals on the front lines in collaboration with their patients. And those approaches require time, resources, and energy that are beyond what is available to many practices that are struggling to keep up with a rapidly changing world.

Payers are in a difficult spot. They want to tie reimbursement to value (i.e., quality and cost). Although payers can measure cost with much accuracy, physicians are in a much better position to evaluate the quality of care patients receive. Thus, payers can try to tie reimbursement to value but do so imperfectly or abandon the effort and fall back to the unsatisfactory volume-based or capitation-based system…or perhaps there is a happy medium where payers can collaborate with physicians to improve quality of care and value to the healthcare system.

HT: Incidental Economist.

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