QUALITY: Payment Debates At The World Health Care Congress
April 24th, 2007
by
Jane Hiebert-White
|
The Washington Convention Center was abuzz as nearly 2,000 health industry and policy wonks gathered for the 4th annual World Health Care Congress. The standard policy topics of cost, quality, and coverage were up for debate, along with competition, effectiveness, transparency, and, of course, reform. For comprehensive blogging on the event, check out the official World Health Care blog. Here are a few “snapshots” from yesterday’s speakers:
Quality data: After posting a slide on “Outcomes Assessment Gone Bad,” Brent James, vice president for medical research of Intermountain Healthcare, explained that there are 3 ways to get better data on quality outcomes:
1. Measure, manage and improve the system–which he acknowledged is “hard to do.”
2. Suboptimize
3. Game the numbers so you look good on the data, rather than improving the system. James said he’s been collecting examples of this.
James also noted the difficulty for consumers in using quality data once they are actually in hand. In making decisions, he said, “stories trump data and relationships trump stories.”
Pay-for-performance: Former British health minister Tom Sackville discussed his concern with physician payment penalties/rewards. “Doctors are highly trained, independent professionals, and they have their pride. If some distant civil servant starts withholding money or throwing [physicians] bits of fish, they will start behaving like naughty children or trained seals.”
Physician view on quality payment: In a question-and-answer session on Medicare payment, American Medical Association president-elect William Plested confirmed the view that physicians chafe under payment for quality programs. “Quality has been job 1 for the AMA since its founding. . . . The real crisis is who is going to pay.” He continued, “We’re not trained to follow the dictates of those who have no medical training.” He concluded by voicing concern for the “pell-mell rush to pay for performance today.”
AARP weighs in on quality: John Rother, director of policy for AARP, contended that “quality does make a big difference. It does vary.” He stated, “Adherence to evidence-based medicine is the highest form of medical ethics. This is an ethically based discussion. . . . The only way to improve quality is to measure it.”
CMS on quality: Herb Kuhn, acting deputy director of the Centers for Medicare and Medicaid Services (CMS), acknowledged the difficulties inherent in Medicare’s efforts to measure quality outcomes and institute pay-for-performance incentives. “Because it’s hard doesn’t mean it’s not worth doing” [audience applause].
Consumer-driven plans: Office of Personnel Management (OPM) director Linda Springer noted that some 20,000 U.S. government employees are now in high-deductible consumer-driven insurance plans. She expects to see that number rise. Larry Glasscock, chairman, CEO, and president of WellPoint Inc., put consumer-driven plans first on his list of 4 steps to help moderate the unsustainable growth rate of U.S. health care costs. These plans “put the consumer back in the middle of health care decisions–exactly where the consumer needs to be.”
Price transparency: Panelists debated the need for transparency of prices to the consumer for these growing consumer driven plans to result in more cost-conscious and informed consumers. Cleveland Clinic CEO Toby Cosgrove noted his organization’s “drive to transparency” and “drive to value in health care dollars.” However, when asked if the Cleveland Clinic publishes its fees for services, he replied that it is “difficult . . .. What do we publish? Actual costs? Different reimbursement rates?” And herein lies the difficulty for consumers–when even an organization whose leadership has a goal of transparency cannot publish a price list for comparison shopping.
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