Long debate The new measures have already cost millions in hospitals, with accusations by the nation’s top hospital groups to grade the quality of care provided by hospitals with a vastly different patient population in the open this week Can and they should be scraped.
In a letter late Tuesday, the American Hospital Association, the Association of American Medical Colleges, the Federation of American Hospitals, and Essential Hospitals of America say the measures are “flawed” because they take into account key social and demographic factors outside the hospital Keep it. Control that may affect the recovery of patients.
He filed a complaint in a formal appeal to the organization that supports the new measures, the National Quality Forum, setting the standard for hospital performance measurement, along with the nonprofit price imposed by Congress.
Chief Science Officer of NQF, Dr. “We will pull all the groups together and think about what is the way forward,” Helen Burstein said on Friday.
Hospitals are particularly concerned about the new measures as they compare hospitals based on the cost of their care for three common and costly conditions: heart attack, heart failure, and pneumonia. Introduced by the Center for Medicare and Medicaid Services, they support methods by the NQF to include social and demographic information about patients on a two-year exam.
These measures have not yet been included in Medicare pay-for-performance programs. But hospital officials say there is a real possibility that they may eventually cost the hospitals millions in Medicare reimbursement. Medicare already imposes financial penalties on hospitals with high readable rates, doing so as chief health care officer of the Association of American Medical Colleges, Dr. Janis Orlovsky says.
“Hundreds of millions of dollars are being spent in hospitals,” says Orlowski. “Do hospitals take care of more disadvantaged people who are punished?”
Hospitals have taken these performance measures into account factors beyond their control that may reflect badly on their quality of care. For example, newly discharged patients who cannot refill prescriptions or go to the primary care doctors are more likely to return to the hospital than those they are seeking treatment for. Is required. Hospitals pay the price of these flaws in community care through high readable rates and high costs. The performance scores of both hospitals can be negatively affected.
Perhaps the biggest challenge is to reliably measure factors that identify patients who are poor or who lack social support networks. Researchers have proposed several options, none of which have yet to be ruled out, Burstein said at the group’s annual meeting.
The simplest option involves giving more credit to hospitals if they treat more racial and ethnic minorities. Researchers have also suggested identifying hospitals with patients who are eligible for both Medicare and Medicaid, indicating a real financial need. Neither approach has proved reliable, Burstein says.
She says other options under consideration include using nine-digit zip codes or census data that indicate people living in disadvantaged communities.
Beth Feldpush, senior vice president of policy and advocacy at Essential Hospitals in the US, says that service to people may be viewed unfairly in safety-net hospitals and academic medical centers.
“They have a lot of patients, they have a lot of Medicaid patients, and they provide a lot of services that are unique in their communities,” says Feldpush. “They have trauma centers, burn centers, neonatal intensive-care units and other high-intensity services that are not in community hospitals.”
But the data also suggest that some hospitals charge significantly more than others and achieve similar results. For example, the study found a two-fold change in the cost of care for heart attacks.
“What CMS wants to do is reduce the amount of variance in care and cost and the relationship between cost and quality,” says Kristen Barlow, a senior consultant at the Advisory Board, a health care consulting firm. “This is another sign that CMS are doubling the relationship between their payments and results.”
The groups also objected to an analysis that considered using race – “black” or “non-black” – as a crude proxy for social and other factors that affect care.
The NQF’s own expert advisory panel ruled that there is no evidence to suggest that race can serve as a proxy for external factors that affect patients’ recovery. Instead, he proposed using dual eligibility for Medicare and Medicaid, a federal insurance program for the elderly, the disabled, and the poor, as a more simple indication that patients are vulnerable. Unfortunately, Burstin says, this method also proved to be unreliable.
Orlovsky of the Association of American Medical Colleges says that being black does not mean a patient is poor or has an inadequate support network. Similarly, being “non-black” does not mean that a person is more affluent, especially when it is a catch-all category including other racial and ethnic minorities.
“If you’re just dividing the world into blacks and non-blacks, you’re putting together people who are poor and rich who don’t mean anything in any way,” Orlowski says.
On the question of race, Burstyn says, “We couldn’t agree more.”
The next and most important step, she says, will be a comprehensive effort to use this approach not only to measure hospital performance, but to ensure that patients, regardless of their backgrounds or circumstances, receive high quality care. get receive.