The quality of healthcare services is so complicated, then how to incorporated the true "quality and value" into the payment system? below is from Jason's <Health Reform's Value-Based Purchasing Provisions>:
The Affordable Care Act of 2010 includes a number of provisions to study and/or implement value-based purchasing (VBP) programs in the United States' health care system. These provisions target Medicare payment policies in particular. Today I review a Robert Wood Johnson (RWJ) article which provides an overview of the ACA provisions related to VBP.
There are four Sections of the ACA which I will focus on: Section 3022, 3007, 3013, and 3021. Let's get to it.
- Section 3022 calls for a Medicare Shared Savings Program, which would provide payments specifically for new accountable care organizations. The legislation specifically requires measurement and assessment of quality as reflected in clinical processes and outcomes, patient and caregiver experience with care, and utilization reflecting efficiency and effectiveness of care, such as hospital admissions for ambulatory care sensitive conditions.
- Section 3007 creates a new "value-based payment modifier," which, starting in 2015, will be used to provide differential payments based on quality and cost of care. Since the payment adjustments are to be budget neutral, some physicians would receive bonuses and others penalties under this provision. Presumably, the IOM's study will be influential in determining how CMS might apply a value-based payment modifier.
Further, the Act continues to advance the notion of bringing value into payments made to physicians, hospitals, and other providers through established payment mechanisms:
- Section 3013 provides for the identification of gaps in quality measures and authorizes (but does not appropriate) funding intended to fill those gaps, relying on collaboration between CMS, the Agency for Healthcare Research and Quality (AHRQ) and the National Quality Forum, which will be primarily responsible for identifying the measure gaps. Priorities are to be given to the following areas: i) health outcomes; ii) functional status; iii) coordination of care; iv) meaningful use of health IT; v) safety; vi) patient experience; vii) efficiency; and viii) disparities.
- Section 3021 creates a Center for Medicare and Medicaid Innovation within the Centers for Medicare and Medicaid Services to test payment and service delivery models that reduce costs while preserving or enhancing the quality of care provided under Medicare, Medicaid, and CHIP, and funds it at $10 billion every 10 years. The legislation specifically suggests pursuing models that transition providers away from fee-for-service and toward comprehensive pay
Source:
- Berenson RA "Moving Payment from Volume to Value: What Role for Performance Measurement?", Quick Strike Series, Urban Institute, Robert Wood Johnson Foundation, Dec 14, 2010.
