Qual­ity Pre­par­ing for pay­ment changes

Modern Healthcare - - SPECIAL REPORT -

The up­com­ing year will likely bring big changes on the qual­ity front as the CMS rolls out the next phases of its value-based pur­chas­ing pro­gram and other in­sur­ers step up their ef­forts to link pay­ment to per­for­mance, ex­perts say.

Fi­nal­ized in April, the govern­ment’s val­ue­based pur­chas­ing pro­gram ties a por­tion of hos­pi­tals’ an­nual pay­ment up­date for 2013 to per­for­mance on se­lected clin­i­cal process-of-care mea­sures and pa­tient-sat­is­fac­tion scores.

Although the ini­tial frame­work is in place, 2012 will be a crit­i­cal year as the CMS in­tro­duces new re­quire­ments to the pro­gram and hos­pi­tals ramp up their reporting ca­pa­bil­i­ties, says Stu­art Guter­man, vice pres­i­dent for pay­ment and sys­tem re­form at the New York-based Com­mon­wealth Fund, and ex­ec­u­tive di­rec­tor of its Com­mis­sion on a High Per­for­mance Health Sys­tem.

“There’s still a lot of work that re­mains to be done,” Guter­man says, re­fer­ring to the val­ue­based pur­chas­ing pro­gram, as well as other re­cent changes, such as the fi­nal rules for ac­count­able care or­ga­ni­za­tions. “The next year or two will re­ally in­volve tak­ing these new ideas and putting them in place.”

Guter­man also pre­dicted that pay­ers will in­crease their ef­forts to make con­nec­tions be­tween providers that are ahead of the curve on qual­ity im­prove­ment and those who may still have a ways to go. “We are be­yond think­ing that one model will work for ev­ery­one, but there are el­e­ments there that all providers can use,” he says.

Some hos­pi­tals have been mod­el­ing the po­ten­tial ef­fects of value-based pur­chas­ing for some time, says Mar­i­anne Udow-phillips, di­rec­tor of the Ann Ar­bor, Mich.-based Cen­ter for Health­care Re­search & Trans­for­ma­tion, a not­for-profit part­ner of the Univer­sity of Michi­gan. Other or­ga­ni­za­tions with fewer re­sources are play­ing catch-up, she says.

The ever-in­creas­ing fo­cus on qual­ity will have other con­se­quences, Udow-phillips says. VBP and ACOS will ac­cel­er­ate the in­te­gra­tion trend among hos­pi­tals and physi­cians, she pre­dicts. “It’s hap­pen­ing al­ready, but I think those two ini­tia­tives will bring hos­pi­tal staff even closer to­gether as they fo­cus on qual­ity im­prove­ment.”

—Mau­reen Mck­in­ney

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