The mechanisms for how hospitals will be paid based on quality measures — and how HCAHPS will fit into those calculations — has left much of the industry watching the unfolding health care reform debate with bated breath. If we keep waiting, we’re in danger of passing out. That is not to say that meaningful payment reform or answers to the many unanswered questions won’t occur in the near future. It’s just that we need to be careful about what we put off doing while we are waiting for definitive answers.
I just returned from the National Quality Forum’s spring meeting. I always find it an interesting mix of perspectives and updates, with many of the key figures and veterans in health policy and health reform present and exchanging ideas. This time I was struck by a theme that seemed to emerge again and again: There are changes to the health system that are taking place now or may occur without — or in spite of — the end game on Capitol Hill.
Janet Corrigan, president and CEO of the National Quality Forum, opened the meeting with remarks about the state of the reform debate. She talked about the three core elements of reform that need to go forward regardless of what happens legislatively. It was no surprise that aligning payment with value was one of those key elements.
Susan Dentzer, editor -in-chief of the policy journal Health Affairs
, gave an evening keynote and described changes at play in health care that are bigger than any legislated reform — shifts in consciousness that once raised can’t be put back in the bag. She described a top 10 list of those ideas, including the growing recognition that the U.S. health care system isn’t always the best in the world, the emphasis on building a wellness system instead of just a sickness system and — not surprisingly — the concept that incentives matter and we get what we pay for.
The current reform legislation — which is basically the Senate-backed bill — is still awaiting action by the House. It describes a process by which 2% of hospital reimbursement ultimately would be withheld, with the opportunity to earn back those monies based on the hospital’s level of attainment
(how well they are performing) and improvement
(magnitude of positive year-over-year change). We know that HCAHPS is planned to be a part of the model along with clinical measures and infection rates, with efficiency measures to be added later. The proposal suggests that 2010 be the baseline year of implementation with 2013 being the first year that monies would be withheld. And the amount to be withheld would start at 1% and scale upward a quarter of a percent each year to the maximum of 2%. What we don’t yet know is what will happen to the funds that are retained — will they be redistributed to higher-performing hospitals or will they represent cost savings to total health care spending?
The other thing that we know is that hospital organizations are not in the same state of bated breath as the pundits might be; they simply don’t have that luxury. Each day patients are cared for and challenges are faced and surmounted. One health care executive I’ve spoken with commented that he’s pretty sure that if reform occurs he’ll have lower reimbursement and if reform doesn’t occur he’ll still have lower reimbursement. His prediction may not come true, but it points to a pragmatic attitude of buckling down to continue to get the job done.
At the National Quality Forum, Michael J. Dowling, president and CEO of North Shore-Long Island Jewish Health System, gave a passionate acceptance speech upon receiving the NQF National Healthcare Quality Award. He described the never-ending effort of his staff to care for patients. The national health care system may not be perfect, he said, but it doesn’t mean that in ways large and small, providers aren’t striving to improve. There are endless examples of incredible personal care being delivered. He reminded the audience that “we are all reformers; we are all change agents.” It’s clear how much he recognizes and encourages incremental change within his organization, and that he is not waiting or holding his breath. And after some discussion of the question of health care reform noted that the question we should be asking is, “Can we do better for the patient? And the answer had better be ‘Yes.’”
Get insights on performance improvement
from other Press Ganey experts.