Appropriate Use Criteria, or how I learned to love CMS telling doctors what to do

As part of Section 218(b) of the Protecting Access to Medicare Act, CMS instituted the appropriate use criteria (AUC) for the use of advanced diagnostic imaging.  In order to be reimbursed for these diagnostic imaging services, physicians must consult with and document that they used AUC software before recommending advanced diagnostic imaging.  Failing to document use…

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…

Does more spending improve outcomes?

A number of studies have claimed that increased health expenditures may result in no better, or even worse outcomes.  For instance, a paper by Fisher et al. (2003) looking at patients with acute myocardial infarction, colorectal cancer, or hip fracture finds that “Quality of care in higher-spending regions was no better on most measures and…

A cancer tool to improve survival?

A recent paper by Basch et al. 2017, found that electronic patient-reported symptom monitoring improved patient overall survival by 5 months.  This finding came from a randomized clinical trial at Memorial Sloan Kettering. For patients in the arm with electronic patient-reported symptom monitoring, when “…participants reported a severe or worsening symptom, an email alert was triggered to a clinical…

What does “value” mean to patients?

There are numerous value frameworks being developed by an alphabet soup of organizations including ACC/AHA, ASCO, ICER, MSKCC, NCCN, and others.  These organizations generally represent providers or payer perspective on value.  But what does “value” mean to patients? The National Patient Advocate Foundation (PAF) provides their thoughts in a recent white paper titled “The Roadmap to…

Diagnostic Ability and Quality of Care

Quality of care often is seen as how physicians and other health care providers treat patients with a given disease.  Accurately diagnosing the disease a patient has, however, is in almost all cases a necessary condition to provide high-quality treatment.  Nevertheless, a physician’s ability to accurately diagnose a disease is rarely measured within exsting 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;…