Health care reform can’t wait for measures to become perfect

by | October 13, 2017 12:43 pm



There’s a debate in the U.S. about whether the current measures of health care quality are adequate to support the movement away from fee-for-service toward value-based payment.

 

The four of us, leaders of organizations that represent large employers and other purchasers of health care, reject any delay in payment reform efforts for the following three reasons:

 
— EVEN IMPERFECT MEASURES ACCELERATE IMPROVEMENT.

One set of measures often questioned is the Agency for Healthcare Research and Quality’s (AHRQ) Patient Safety Indicators (PSIs) used by the Centers for Medicare and Medicaid Services (CMS) and others in value-based payment programs. These indicators measure surgical complications and errors in hospitals, which is critical given that one in four hospital admissions is estimated to result in an adverse event.

 
Use and reporting of PSIs through AHRQ’s Medicare Patient Safety Monitoring System has measurably improved quality. For instance, CMS reported a reduction in inpatient venous thromboembolisms (VTEs) from 28,000 in 2010 to 16,000 in 2014, meaning that 12,000 fewer patients had potentially fatal blood clots in 2014.

 
— USING MEASURES IMPROVES MEASUREMENT.

Use of measures is often necessary to break logjams in correcting the health care industry’s long-neglected weaknesses in data-quality control. Indeed, many of the nuanced imperfections providers criticize were only uncovered by public reporting, which revealed unexpectedly poor performance for some providers, prompting them to research the medical records to find out the reasons.

 
— RETURNING TO FEE-FOR-SERVICE IS NOT AN OPTION.

Given the widely acknowledged waste, heavy costs, and quality-of-care issues produced by the fee-for-service system, the fact that there are rough spots on the road to value-based payment is hardly a justification for slowing down reform. If it were easy, it would have been done a long time ago.

 
(Brian J. Marcotte is president and CEO of the National Business Group on Health. Annette Guarisco Fildes is president and CEO of the ERISA Industry Committee. Michael Thompson is president and CEO of the National Alliance of Healthcare Purchaser Coalitions. Leah Binder is president and CEO of the Leapfrog Group.)

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