Underserved Populations and Hospital Pay-for-Performance
In the healthcare reform debate, hospital pay-for-performance has received plenty of discussion—how it could impact health outcomes, how it could promote efficiency, how it could change care coordination. In 2013, we’ll see the first step toward hospital pay-for-performance: hospitals will have some revenues withheld by Medicare and then returned if they meet specific clinical targets.
According to a new study published in the Journal of Public Library of Science, there are economic and human resource issues that may hinder some hospitals from meeting those pay-for-performance targets. And if that happens, the study’s authors are concerned that funding will be taken away from hospitals that provide care in poor and underserved communities.
The study’s lead author, Jan Blustein, MD, PhD, a New York University professor of health policy and medicine, analogizes hospital pay-for-performance with the “No Child Left Behind“ initiative for education that was started several years ago. In an interview earlier this month with HealthLeaders, Dr. Blustein said, “’One of the problems is we know very little about what helps and what works.’ In education, schools are told to do better—‘but there is no science there.’”
Dr. Blustein goes on in the interview, “’And the same thing is true in healthcare. We know a lot about what works to improve a patient’s health, but we really don’t know about what works to improve organizational performance.’”
And this is where I part ways with Dr. Blustein and her colleagues. In their study nearly 33% of the hospitals were in disadvantaged counties, and the researchers concluded that a pay for performance model might “exacerbate inequalities” across regions by rewarding hospitals located in regions that are rich in economic and human resources—and punishing facilities that are in disadvantaged locations.
There is “science” behind results that have shown that hospitals can have better outcomes, even in underserved communities. Pharos Innovations’ own success with Henry Ford Hospital and with South Jersey Healthcare, immediately come to mind. In addition, there have been third party validated Medicaid population demonstrations utilizing our Tel-Assurance platform that have shown reductions in readmissions, and subsequently millions of Medicaid dollars saved. We’ve worked with critical access hospitals in several underserved communities and seen similar impact. In the soon to be published TELE-HF trial, sponsored by the NIH, several high risk, low income communities and populations were intentionally recruited to participate in this randomized clinical trial.
“Holding providers accountable is not an unreasonable approach to quality improvement,” the researchers conclude, but it should be done “in a way that attends to the profound inequalities in local circumstances that shape life in the 21st century.”
No one can argue that profound inequalities exist in communities within our country, and we don’t think anyone can argue with the notion of holding healthcare providers accountable for their performance. But, there are some solutions that transcend populations served and work consistently even within otherwise dramatically different healthcare “systems”. Perhaps solutions that help healthcare providers deliver better care while saving money in whatever organizational setting they find themselves practicing should be given a closer look.
Tags: Care coordination, CMS, Healthcare reform, Medicaid, Medicare
