Quality:
Batten Down The Hatches For Pay For Performance
Published on Thu Jan 20, 2005
MedPAC recommends payment incentives for quality indicators. Heads up, HHAs: As early as next year, your patient outcomes may become more important than ever.
In its Jan. 12 meeting, the Medicare Payment Advisory Commission voted to recommend pay for performance for home health agencies, as well as hospitals and physicians. The P4P methodology would be based on a "starter set" of 11 currently collected, OASIS-based patient outcomes.
The influential advisory body to Congress recommends basing only 1 to 2 percent of payments on outcomes to start. But that percentage could quickly increase. "As the information and data and mechanisms for doing this fairly and accurately improved, the size of the pot would get bigger and bigger," MedPAC Commissioner Robert Reischauer said in the meeting.
In earlier meetings, commissioners voiced concerns over whether the patient outcomes could serve to distinguish between agencies. "In nine of the 11 publicly reported measures there was a range of 90 percentage points from the top to the bottom, and in 10 of the 11 there were standard deviations of about 10 percentage points," MedPAC staffer Sharon Cheng assured.
MedPAC does rule out using emergent care and rehospitalization adverse events to influence payment rates. "The current measures cannot adequately identify cases that were due to poor care, nor are they adequately risk adjusted," Cheng noted in the meeting.
"We're not there with adverse events," Commissioner Carol Raphael, CEO of the Visiting Nurse Service of New York, agreed. "It's too small a sample. We need to do a better job in risk adjusting."
"It was positive that they pointed out the problems with OBQM adverse events," says Bob Wardwell of the Visiting Nurse Associations of America. But don't expect that prohibition to last long. MedPAC has "a strong preference for using the measures for emergent care and hospitalization," Wardwell suspects.
Indeed, MedPAC voted to recommend that the Centers for Medicare & Medicaid Services develop a valid set of measures of home health adverse events and include adequate risk adjustment for them.
As far as the National Association for Home Care & Hospice has discovered, pay for performance incentives have never been tried in the home care setting before, notes William Dombi, vice president for law with NAHC's Center for Health Care Law. Switching to P4P is a "dramatic philosophical change," Dombi says.
Congress will find it comparatively easy to pass P4P this year, because it is a budget neutral initiative, Dombi tells Eli. Exactly how P4P would affect HHAs is unclear, because MedPAC leaves the details of the system up to Congress and/or CMS to figure out.
But the move to the quality incentive system is "potentially alarming," Dombi warns. Unless the system is set up just right, agencies could find themselves financially rewarded for taking on [...]
