Home > Health care > Shifting Medicare payments from quantity to quality

Shifting Medicare payments from quantity to quality

Medicare is preparing to begin paying hospitals for the quality — not the quantity — of the care they provide. Not surprisingly, hospitals are less than delighted.

According to the rules published last week, in 2012 Medicare will start setting aside 1% of total hospital payments to create a pool from which it would pay bonuses to hospitals that have the best scores — or that show the most improvement — on various measures of quality care. In 2016, the bonus pool would increase to 2% of total hospital payments. (I’m linking to the Kaiser Health News story for its comprehensiveness and overall fairness.)

Ashish Jha, a Harvard School of Public Health professor, told KHN:

“In many ways, it’s a watershed moment for the health care system. It’s a modest amount of money and not something that’s going to radically change the way we pay for hospital care in America. But it’s a really important step toward paying for better care and not just for more care.”

70% of the bonuses will be focused on 12 measures of how well hospitals apply clinical guidelines to patient care: giving anti-clotting drugs to heart attack patients, or giving antibiotics to patients about to undergo surgery. The hospitals seem untroubled by this part of the program; they should be able to manage the treatment process.

But the remaining 30% of the bonus pool will be distributed based on patients’ satisfaction with the care they received: how clean were the rooms, how well did doctors and nurses communicate, how effectively pain was controlled. Hospitals don’t like this part.

Hospital groups had unsuccessfully pushed federal officials to reduce the influence that patient views would have on their payments, arguing that the surveys didn’t always reflect reality and would penalize hospitals in some regions where patients are less forthcoming with praise.

Eventually, Medicare will also use measures that track patient outcomes, not just hospital processes. After all, treatments should achieve positive results, shouldn’t they?

Bill Sez: As a retired health-care worker, I understand…and sympathize with…the discomfort about tying payments to patient satisfaction. It can be really, really difficult to improve satisfaction scores, because you have to get patients to rate you “4” instead of “3” or “5” instead of “4.” Still, there is a substantial knowledge base about health-care quality improvement, so it’s not impossible.

Categories: Health care
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