Value-based payment initiative raises questions about how to measure quality

Many providers and payers have taken a wait-and-see approach to the Department of Health and Human Services' recent announcement that it will shift Medicare provider payments from a fee-for-service model to a quality-based system. But some already wonder how exactly the agency will measure "care quality" at the many healthcare facilities affected by the policy.

Last year, 33 federal programs asked healthcare providers to submit data on a total of 1,675 quality measures, the Wall Street Journal reported, noting that these figures don't even include the measures that state, local and private health plans take into account.

"Measurement fatigue is a real problem in hospitals," Scott Wallace, a visiting professor at Dartmouth's Geisel School of Medicine, told the newspaper. "But, to me, the only metric that matters is, did you get better?"

To help whittle down the number of overall quality measurements, the National Quality Forum (NQF), as part of the Measure Applications Partnership, recently issued recommendations about the best use of available measures in 20 federal programs. Its recommendations intend to streamline the quality measures to include outcome-related metrics as well as factors such as patient satisfaction and experience, NQF President Christine Cassell told the Washington Post.

"In order for payment models based on value to really work, all providers need clear, consistent measures that drive improvements in care and provide meaningful information for patients, while being clinically relevant and actionable for providers," Cassel wrote in a statement.

The Centers for Medicare & Medicaid Services already ties its payments to key outcome-based quality metrics such as the reduction of readmissions and hospital-acquired infections (HAIs). The results for providers have been a mixed bag--while many hospitals recently stood to get bonuses due to quality improvements, many will experience little net gain due to penalties assessed under other Medicare programs, FierceHealthFinance previously reported.

But the transition to a value-based model may already pay off for patients: A recent Centers for Disease Control and Prevention report indicated that hospitals have made significant strides in HAI reduction, though there is still much room for improvement in the effort to eliminate preventable patient harms, according to FierceHealthcare.

For Cassel, the promise of a value-based payment model is clear.

"We have to move away from fee-for-service payment because it just doesn't accurately reflect the complexity of the kind of care that patients need," she told the Washington Post.

To learn more:
- read the Wall Street Journal report
- here's the Washington Post article
- access the NQF recommendations
- check out the NQF statement

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