Tuesday, November 8, 2011

Pay-for-Performance to Improve Quality at Rhode Island Hospitals

Reflecting a move underway in many parts of the country - including with the federal government - insurers are now looking to compensate hospitals and providers more on the basis of quality measures/ outcomes rather than simply for the delivery of service. Part of the drive to do this is simple cost containment - it gives the insurers a means to keep the growth of healthcare costs pegged at general inflation. The other main driver is to improve quality - despite developing a world-beating medical-industrial complex in the US, the system has become so complex, the need for coordination of care so intense, that many providers are failing in their ability to deliver high reliability for relatively simple, non-controversial, "evidence-based" clinical care processes. Many of these failures in the undertaking of "process measures" also add up to failures in "outcomes measures" (the ultimate objectives of delivering care) - including readmissions, mortality, and complications.

This article in Providence Business Journal demonstrates how Blue Cross Blue Shield of Rhode Island is working with hospitals to incentivize them for quality. One of the points that this article doesn't make is that the data for how most hospitals are doing is publicly available on a website developed by the federal government:
 Hospital Compare (www.hospitalcompare.hhs.gov). Its important for consumers to know this as "transparency" and "consumerism" are two of the big movements driving improvements in quality and safety in the US. 

While the overall objectives of the BCBS of RI initiative are commendable, the measures that the incentive payments are targeting are mostly process measures. From a quick review on Hospital Compare, many of the state's hospitals are already doing well on these process measures. There do appear to be opportunities to improve the "patient experience of care" measures state-wide, however, whether these measures are a true reflection of quality is being actively debated.

The real need is tackle the more complex outcomes measures, which certainly appear to be an area of opportunity at some of the state's hospitals, particularly for readmissions:

The good news is that groups like Rhode Island Quality Partners and Rhode Island Quality Institute are working on improving systems to improve "transitions of care" which can lead to reductions in readmissions. More work like this needs to be supported so that the healthcare system can meet the needs of the public in a high reliability, high quality, and high patient safety manner.

Complication rates (also reported on Hospital Compare) appear to be a challenge for some hospitals in the state. I'll write more about that in a subsequent blog.

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