Pay-Per-Performance and Quality Reporting

To an outside observer there is no reason why hospitals and doctors would resist attempts to improve the quality of the services they provide. After all, better healthcare should be a win-win proposition for all concerned. The devil, as usual, is in the details. And what exactly constitutes "better healthcare" turned out to be the subject of much debate.

2005 was the year that the Centers for Medicare and Medicaid Services decided to launch a serious push for quality reporting. There have been some successes, with most hospitals getting involved in limited quality reporting and nursing homes showing some substantive quality improvements. Private organizations, like the Integrated Health Association in California and Bridges to Excellence in several cities, are having some success in motivating physician behavior. But organized medicine is becoming increasingly unhappy with what they see as an effort to impose a one-size-fits-all form of medicine from above and its connection to cuts in the Medicare fee schedule.