How should Medicare and Medicaid measure doctors, hospitals, dialysis centers and other health care providers the government pays? There are 368 new ideas on the table this year, according to a list compiled by the Centers for Medicare & Medicaid Services. CMS estimates 60 will be adopted in 2012.
Photo by Adafruit Industries via Flickr
Figuring out how to fairly and accurately assess the care that health providers are giving is a key component of the Affordable Care Act’s effort to move the government and private insurers away from paying for the quantity of services provided and instead making reimbursements based on the quality and cost-efficiency of that care.
Some of the measures aim to assess specific areas of serious concern, such as the excessive use of restraints on patients in psychiatric hospitals and the percent of babies born in a hospital who were delivered by choice before a full 39 weeks of pregnancy. Others are broader, such one measuring how often families of people who died in hospice thought the program was satisfactory.
The measures were proposed by a variety of places. Some came from government agencies such as CMS and the Centers for Disease Control and Prevention. Others were devised by industry groups or companies such as the Hospital Corporation of America, the National Hospice and Palliative Care Organization and the American College of Cardiology. Still others come out of academic or research groups, such as the University of North Carolina and RAND.
Before it decides which measures it wants to use, CMS asked the Measures Application Partnership, a stakeholder group established by the National Quality Forum (NQF), to give advice on which measures will accurately and fairly capture provider performance. The group will issue its recommendations to CMS. That list is due out by Wednesday. CMS will then take the group’s input — as well as that of others — as it decides which measures to include in regulations it develops over the course of the year and beyond.
“There are measures in here that address gaps, there are others that really need development, and then there are some where the [partnership] said ‘that’s not a high priority,’” said Tom Valuck, a senior vice president at the forum in charge of the partnership.
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The neanderthals will not like this! Those that want to repeal the Affordable Care Act (ACA) are dead set against any new ideas. They think like cavemen. They talk like cavemen. They live like cavemen. In fact, they would be much happier living in prehistoric times. Most cavemen would rather fight a protracted war in Iraq or in Afghanistan than fix our broken health care system. The Tea Party is made up mostly of cavemen and cavewomen. I wonder why Michelle Bachmann dropped out of the race to be President. Isn’t she supported mostly by cavemen? Doesn’t she want to repeal the ACA and turn back the clock to sometime around the mid 19th century? Neanderthals!
I totally agree! How can people justify trillions of dollars for “un-winable” wars but can walk pass those who end up in the emergency room because they can’t afford preventive care, or those who have jagged mouths because they can’t afford basic dental care. Yep, the ones that can afford to do this are congress and other government leaders. They are the ones who come in at one income level and leave millionaries. And, please don’t forget those who are unemployed and are given the wonderful choice of COBRA with higher premiums than those who are working. What a corrupt country we have become!
Attitudes like this are why we have problems in this country. Polarization and demonization are used instead of understanding and respecting the opinions of others. I’m for lots of new ideas that eliminate claims processing and administrative overhead but for repeal of PPRA. The money wasted on paperwork could be redirected to caring for patinets and still have a cost savings………just saying guys losing the hyperbole and attempting understanding would go a long way to fixing problems instead of letting the pols use the problems to raise money for their reelection
To JK: I applaud your plea for an end to polarization! Hear hear. Let’s have a fair and honest debate about the topic, not a bunch of name-calling. (And I assume you mean PPACA? Not sure what PPRA is.)
As for “redirecting money wasted on paperwork” into caring for patients – sounds great but really a huge oversimplification of the issue. To your point, however – one thing that PPACA will reduce is the constant paperwork generated by insurance carriers attempting to deny claims because of “pre-existing conditions” – so you should be for the bill, not against it!
CMS need only look to what innovative employers as well as accreditation/certification orgs are using to measure quality — if CMS is the appropriate party to measure quality. And I believe CMS is not the appropriate party. The private sector has hundreds, even thousands of quality metrics and yet — after Mcaid has existed for 50 years — it adopted its first set of 26 quality measures just recently.
Quality measurement must be from independent sources and the govt isn’t independent –it’s too much influenced by special interests as well as the inherent conflict of changing definitions to justify govt initiatives (read propaganda).
Re ObamaCare ending denials for pre-existing conditions, only 55 K signed up as a result of the law while the estimate was something like 15 million. I’m all for ending denial based on preexisting conditions, let’s not overstate the case and thereby overbuild a solution that doesn’t fit the problem.
CMS is NOT willing to take a stand in recommendations for professional societies and national quality improvement organizations, i.e.: Leapfrog recommendations for ICU care. These are about people dying in the ICU because wrong care at the wrong time by the wrong provider. If CMS ignores these evidence based practices, I reservations about the true willingness of CMS to take bold and hard decisions.
MC
Quality is a subjective as well as an objective thing. It is also a very human thing. When we can get back to interacting with persons and not clicking data marks on a computer, only then can we achieve true QUALITY health care!