Tying Medicare Payment to Quality

[Greenbeard]

Cass, er I mean Green, is "value-based purchasing" supposed to be a new and novel idea to "Bend down the cost curve"?

There's only one field/sector in the world where getting what you pay for is considered a novel idea.

 

[CrusaderFrank]

Cass, er I mean Green, is "value-based purchasing" supposed to be a new and novel idea to "Bend down the cost curve"?

There's only one field/sector in the world where getting what you pay for is considered a novel idea.

Yes, it's called your employer, "Government"

 

[dblack]

Don't be coy. This is about insurance, not health care itself.

As already explained to you, no it isn't. This thread is about hospital care and value-based purchasing. You had some analogy to make which has since deteriorated into your standard irrelevant rants about the individual mandate.

You were responding specifically to my comment out mandatory insurance with the usual bullshit. So yeah, that's what the conversation was about at that point in time.

If you want to talk about something else, start a new thread.

Nah. I'm content to stay here an raise points I consider relevant to the topic. Even if they aren't in line with your agenda.

 

[Greenbeard]

You were responding specifically to my comment out mandatory insurance with the usual bullshit. So yeah, that's what the conversation was about at that point in time.

You've described the "most fundamental right a consumer has" as "the right to say 'no'".

Are you going to say "no" to a hospital when you have a heart event? If not, what replaces the linchpin of your theory of health care markets?

 

[Flopper]

In regard to quality and cost of hospital care, it is difficult if not impossible for the average consumer to select a hospital that will delivery the best service at the best price.

Regardless of outcome or quality of service, the hospital gets their money. In fact, a poor outcome, is likely to generate more revenue for the hospital than a good outcome. Reimbursement based on quality of service and outcome is a good idea. Most likely, the private insurance carriers will continue to look to Medicare policies as the “Gold Standard” and follow in suit with reimbursement formulas that take into account quality of service.

 

[boedicca]

]If you understand that, then why do you support ObamaCare - which is just a massive takeover of health insurance and does NOTHING to improve delivery systems?

Is this a joke?

No, it's not. Health insurance is not health care. Try getting a claims processor at an insurance company to perform your next surgery, if you don't believe me.

Nor will health insurance do you any good when doctors stop practicing or accepting insurance and go all cash.

 

[dblack]

You were responding specifically to my comment out mandatory insurance with the usual bullshit. So yeah, that's what the conversation was about at that point in time.

You've described the "most fundamental right a consumer has" as "the right to say 'no'".

Are you going to say "no" to a hospital when you have a heart event? If not, what replaces the linchpin of your theory of health care markets?

Nah. Healthcare and insurance are not the same thing, regardless of how many times you claim otherwise. You can reject one without rejecting the other.

 

[Greenbeard]

That's interesting, but this isn't about insurance. It's about the quality of hospital care--actual health care delivery. Insurance markets are a different beast than delivery systems.

]If you understand that, then why do you support ObamaCare - which is just a massive takeover of health insurance and does NOTHING to improve delivery systems?

Is this a joke?

No, it's not. Health insurance is not health care. Try getting a claims processor at an insurance company to perform your next surgery, if you don't believe me.

Nor will health insurance do you any good when doctors stop practicing or accepting insurance and go all cash.

Nah. Healthcare and insurance are not the same thing, regardless of how many times you claim otherwise. You can reject one without rejecting the other.

So you both come into a thread specifically on care delivery, repeatedly attempt to divert it with irrelevant carping about insurance, then claim I'm the one confusing the two.

And all with characteristic total lack of awareness. Impressive.

 

[dblack]

That's interesting, but this isn't about insurance. It's about the quality of hospital care--actual health care delivery. Insurance markets are a different beast than delivery systems.

No, it's not. Health insurance is not health care. Try getting a claims processor at an insurance company to perform your next surgery, if you don't believe me.

Nor will health insurance do you any good when doctors stop practicing or accepting insurance and go all cash.

Nah. Healthcare and insurance are not the same thing, regardless of how many times you claim otherwise. You can reject one without rejecting the other.

So you both come into a thread specifically on care delivery, repeatedly attempt to divert it with irrelevant carping about insurance, then claim I'm the one confusing the two.

And all with characteristic total lack of awareness. Impressive.

They're intimately tied together by the law you are pimping. And more generally, we're arguing against the central premise that informs nearly everything you post on health care: that government should be in charge telling all of us how to live our lives.
You might not want to talk about the ideology or the founding principles behind PPACA but it's important to do so. The law represents a radical change in our society and a profound expansion of the role of the federal government in our lives. Moreover, it embraces what, in my view, is the most dangerous trend in government: the merging of economic and political power into one.

 

[Greenbeard]

They're intimately tied together by the law you are pimping. And more generally, we're arguing against the central premise that informs nearly everything you post on health care: that government should be in charge telling all of us how to live our lives.

I enjoy your broken record platitudes, really I do. Very insightful! But what does this have to do with improving care in hospitals?

If you're not interested in talking about the health care system, why don't you try the new philosophy forum? I'm sure the discussion there would be more to your liking.

 

[CrusaderFrank]

Cass, er I mean Green, is "value-based purchasing" supposed to be a new and novel idea to "Bend down the cost curve"?

There's only one field/sector in the world where getting what you pay for is considered a novel idea.

What was it you were going to say?

 

[dblack]

They're intimately tied together by the law you are pimping. And more generally, we're arguing against the central premise that informs nearly everything you post on health care: that government should be in charge telling all of us how to live our lives.

I enjoy your broken record platitudes, really I do. Very insightful! But what does this have to do with improving care in hospitals?

If you're not interested in talking about the health care system, why don't you try the new philosophy forum? I'm sure the discussion there would be more to your liking.

No, it's important to understand the underlying philosophy of what you're selling, and the very real impact it will have on our lives. If you don't want to talk about that - and clearly you don't - I can't force you. But it is pertinent to the topic, vitally so in my view, and I'm not going to 'sit down and shut up'.

 

[Greenbeard]

No, it's important to understand the underlying philosophy of what you're selling, and the very real impact it will have on our lives.

A delivery system based on evidence-based care and accountability for providers will indeed have a real impact on your life: in the form of slower health care cost growth and better quality care.

Even the very modest first steps taking place now are beginning to have an effect on care delivery:

Moreover, hospital administrators are trying to instill a sense of shared responsibility in maintaining high value-based purchasing scores. “I cannot make a physician prescribe an ACE inhibitor when it’s appropriate to deal with heart failure, but the hospital takes a hit for that,” says Dee Rogers, RN, director of quality and risk management at Magnolia Regional Medical Center in Magnolia, Ark. “Not that I want to see people get their hands slapped—I want to see equal accountability.”

Like other hospitals, Rogers’ 49-bed rural facility is tracking doctors’ performance on quality measures and guidelines as part of its credentialing process. Many facilities are starting to include more comprehensive evaluations as part of their contract renegotiations. Magnolia has one weekend hospitalist and is conducting a feasibility study on whether to launch a full-time hospitalist program on weekdays. If the hospital pursues that program, Rogers says, she’d like to see upfront expectations built into the doctors’ contracts.

PeaceHealth, a faith-based nonprofit healthcare system that operates eight hospitals in Oregon, Washington, and Alaska, is moving in the same direction. “I think we’re getting pretty close—certainly within the next year, probably sooner—of creating a reliable mechanism for physician accountability related to the measures that are included in value-based purchasing,” says Laura Dietzel, PeaceHealth’s program director for High-Tech Meaningful Use. That mechanism will connect specific core measures with specific physicians, not just roles or departments.

“We are really honing in on that kind of a quality dashboard, and [VBP’s arrival] is definitely going to be a big boost toward doing that,” says Dietzel, the health system’s former program manager for core measures. “We are talking about making it part of our credentialing process, part of our privileging process, and part of our physician reimbursement and pay schedule process.”

To avoid the most dire “What if?” scenarios, hospitals are enlisting their staff and trying out new tools to help them identify and address trouble spots. At Dr. Torcson’s own hospital, 237-bed St. Tammany Parish Hospital in Covington, La., hospitalists and other staff members are scrutinizing the core measures and tweaking guidelines and best practices to make sure the facility is in top form. Based on initial modeling, the hospital expects to earn back all of its withheld reimbursements, though Dr. Torcson says the push is still on to increase the cushion.

A few QI [quality improvement]] organizations that contract with CMS, including Seattle-based Qualis Health, have developed interactive calculators or mock scorecards to help hospitals determine where they stand in the value-based purchasing scrum. Patricia Richardson, MA, RCP, director of quality and risk for 50-bed Samaritan Hospital in Moses Lake, Wash., says the hospital has worked with Qualis on a scorecard to help staff understand which measures need attention and what the financial repercussions would be if the hospital doesn’t improve.

After earlier pushback from doctors on some core measures, quality-review specialist Rebecca Johnson says Samaritan began posting how individual doctors were performing. “And, over time, that motivated them,” she says. “Nobody wants to be the guy in the red.” Johnson says the hospital’s four hospitalists, though, have been fully engaged. “Our hospitalists are very interested in how we’re doing,” she says. “When I’m on the floor doing my reviews, they consistently ask—all of them—‘How are we doing on the core measures?’ ”

 

[RightNorLeft]

The baby steps toward getting better value for our dollar

Right, because centrally planned price controls ALWAYS do a better job of that than does competition and individual choice....

God you're a nanny state suck up.

What happening doesnt interfere nor have anything to do with competition or indiividual choice. Its making hospitals many of which SUCK improve their performance. If you have a horrible patient record you get less and that is a good thing. Nothing but money in our capitolist society can force change.

 

[Flopper]

The baby steps toward getting better value for our dollar

Right, because centrally planned price controls ALWAYS do a better job of that than does competition and individual choice....

God you're a nanny state suck up.

What happening doesnt interfere nor have anything to do with competition or indiividual choice. Its making hospitals many of which SUCK improve their performance. If you have a horrible patient record you get less and that is a good thing. Nothing but money in our capitolist society can force change.

I agree. Paying high reimbursement rates for poor quality of care only encourages more of the same.