Federal efforts to drive value through bundled payments are falling short of adequately measuring the quality of care provided to patients, researchers from Johns Hopkins said in a recent editorial.
Led by Peter Pronovost, M.D., the former director of the Johns Hopkins Medicine Armstrong Institute for Patient Safety, researchers said health providers should follow a more comprehensive framework for evaluating the quality of care delivered using the bundled payment model, according to the editorial published in the Annals of Internal Medicine.
Specifically, the evaluation required by the Centers for Medicare & Medicaid Services should address if the patient received the appropriate treatment, if the patient recovered or saw an improvement and the cost of the treatment. They should also consider a more comprehensive way to evaluate costs by adding a patient's reported out-of-pocket spending and time off to Medicare's costs.
For example, the researchers applied those broad principles to the CMS' bundled payment program for total knee replacements. They suggest adding criteria to evaluate if the surgery was necessary and to better score patients for risk of disability.
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Adjusting the measurements would better measure value per dollar, too, according to the study. It is also important to account for who is paying for what piece in the bundle, including both what patients pay and what providers may lose in unpaid bills.
Improving measurements, though, will require additional investment in collecting data and growing research around the effectiveness of measures, the researchers said.
"[We] think that the investments necessary to develop and implement these 'measures that matter' will be worthwhile because they will drive high-value innovations in diagnosis and therapy," the researchers said.
Alternative payment models are becoming an increasingly common piece of the reimbursement puzzle. The study notes 29% of reimbursements in 2016 used alternative payment models, including bundled payments.
The study adds to the growing collection of recommendations of how CMS could improve the bundled payments program including extending the duration of bundles, which would allow the model to be expanded to more conditions such as maternity care. They've also recommended moving beyond the hospital and allowing outpatient providers to take on some of the risk and aligning bundled payments with accountable care organizations.