The cost of quality measurement

An interesting editorial in JAMA by Schuster, Onorato and Meltzer (2017) makes the following point: So how should quality measures be prioritized? Many factors are currently considered, including a measure’s expected effect on patients and health care, potential for promoting improvement, scientific underpinnings, usability, and feasibility. But there is a major omission from this list:…

The news you didn’t notice when reading about the $475,000 treamtent

David Augus and and Dana Goldman weigh in on Novartis’ decision to price their new chimeric antigen receptor T-cell (CAR-T) therapy known as Kymriah (tisagenlecleucel).  The treatment represents ground-breaking technology, but is priced at $475,000 per treatment.  But the authors note that there is something else novel about this technology: There was another announcement from…

Medicare’s value-based purchasing fail?

Value-based payment is the latest hot topic.  One question remains, however, does it work?  Does paying for quality improve quality.  A study by Zuckerman et al. (2016) finds that the hospital readmissions reduction program (HRRP) did appear to reduce re-hospitalization rates among the targeted conditions. What about the hospital value-based purchasing program (HVBP).  Beginning in…

Can physician quality be captured by a single composite measure?

Value-based payment for providers is often predicated on being able to measure physician quality with a single composite measures.  For instance, Medicare’ s Value-Based Payment Modifier (Value Modifier) combines a variety of individual quality metrics across domains to create a single quality score.  Payment to physicians is adjusted based on a combination of physician quality…

Measuring the quality of cancer care

How do you measure the quality of care patients with cancer receive?  How long they live?  Avoiding side effects?  Patient satisfaction? Process measures? Further, there are multiple types of cancer and different cancer have different recommended treatments and methods of providing care.  To further complicate the issue, new cancer treatments are being introduced in rapid succession;…

Aligning Incentives

An interesting story at AJMC on a new type of wellness program that better aligns outcomes with reimbursement: “Most wellness programs are like most gym memberships,” Adam Fawer, Noom’s chief operating officer, said in an interview. Employers have spent lots of money on programs that fail to help or even reach most of the staff,…

VBID in TRICARE

Value-based insurance design looks to be expanding. As the American Journal of Managed Care reports: The bill calls for a pilot demonstrating the feasibility of incorporating VBID by “reducing co-payments or cost shares for targeted populations of covered beneficiaries in the receipt of high-value medications and services and the use of high-value providers” no later…