Small Business California: Pay for Performance Update eNewsletter

We hear a lot of negatives about the Affordable Care Act. See below a very positive outcome on Patient Safety. Pay for Performance has done some great things saving lives and reducing costs. It is important people understand that reducing health care cost and improving outcomes are not mutually exclusive.
All the best to you in 2015!

Welcome to the Pay for Performance Update eNewsletter
Editor: Philip L. Ronning
This issue sponsored by the
National Pay for Performance Summit and the
National Healthcare Transparency Summit

Efforts to Improve Patient Safety Result in 1.3 Million Fewer Patient Harms, 50,000 Lives Saved and $12 Billion in Health Spending Avoided
A report recently released by the Department of Health and Human Services shows an estimated 50,000 fewer patients died in hospitals and approximately $12 billion in health care costs were saved as a result of a reduction in hospital-acquired conditions from 2010 to 2013. This progress toward a safer health care system occurred during a period of concerted attention by hospitals throughout the country to reduce adverse events. The efforts were due in part to provisions of the Affordable Care Act such as Medicare payment incentives to improve the quality of care and the HHS Partnership for Patients initiative. Preliminary estimates show that in total, hospital patients experienced 1.3 million fewer hospital-acquired conditions from 2010 to 2013. This translates to a 17 percent decline in hospital-acquired conditions over the three-year period. "Today's results are welcome news for patients and their families," said HHS Secretary Sylvia M. Burwell. "These data represent significant progress in improving the quality of care that patients receive while spending our health care dollars more wisely. HHS will work with partners across the country to continue to build on this progress." (HHS.gov, December 2, 2014)

Pay for Performance Pays off in 50,000 Fewer Deaths
Martin Merritt, JD, applauds the news from CMS cited in the above report. "Critics will certainly argue along the lines of the famous Ronald Coase observation, 'If you torture data long enough, it will confess to anything.' This may be one time, however, when it is OK to be less philosophical. Rarely does the federal government hand physicians a tool that makes life a little better. That's what Office of Inspector General (OIG) Advisory Opinion 12-22 does, and now data backs up the theory, with numbers showing lower program costs, lower injuries and deaths, and greater patient satisfaction." Merritt goes on to explain how relaxed pay-for-performance regulations have engineered the saving of these 50,000 lives. He concludes that "…the OIG had to approve of sharing compensation between the facility and the physicians. Happily, the data suggesting 50,000 lives saved, means the OIG and HHS got one right this time." ( Physicians Practice, December 14, 2014)

How Quality Incentive Payments Vary by Physician Specialty and Position
The Sullivan Cotter & Associates' 2014 Physician Compensation and Productivity survey reports that primary care department chairs have the highest median quality incentive payments among all physician specialties and positions. Surgical specialties see the highest median quality incentive payments.

Check out the graph below, modified from the Sullivan Cotter & Associates' survey.

(Becker's Hospital Review, 2014)

Health Care Pros Confirm It: Coordinating Care of Older Adults Moving Across Treatment Remains a Problem with No Easy Answers: Experts Urge Caution in Implementing Pay-for-Performance Schemes Tied to Coordinating 'Transitional Care' of Older Adults
Alicia Arbaje, MD, MPH, director of transitional care research and assistant professor of medicine at Johns Hopkins Bayview Medical Center and the Johns Hopkins University School of Medicine, was the principal author of "Excellence in Transitional Care of Older Adults and Pay-for-Performance: Perspectives of Health Care Professionals" published in the December issue of the Joint Commission Journal on Quality and Patient Safety. An MDLinx summary of the article follows:
SUMMARY: A study was conducted to characterize health care professionals' perspectives on successful transitional care of older adults (age 65 years and older), suggestions for improvement, and P4P strategies related to transitional care. This study suggests that in characterizing health care professionals' perspectives, specific care processes to target, challenges to address in the design of P4P strategies, and unmet needs to consider regarding education and feedback for health care professionals were described. Future investigations could evaluate whether performance targets, educational interventions, and implementation strategies based on this conceptual framework improve quality of transitional care. (Summary from MDLinx on 12/18/2014)
While the article is only available for purchase at the moment, Johns Hopkins issued a release providing details on the study and its results. According to the release, "the authors note the persistent 'mixed reviews' of the impact of tying compensation to quality of care. They also say that care transitions across health care settings remain "common, complicated, costly and potentially hazardous for older adults." As the ranks of older adults grow and their numerous illnesses require ever more drugs, specialists and facilities, poor transitional care frequently leads to rehospitalizations and complications for patients." (Johns Hopkins Medicine, November 25, 2014)

Reforming Graduate Medical Education in the U.S.
Abstract: The foundation of the U.S. health care system is a workforce of highly competent doctors who are prepared to provide the highest quality health care when they enter practice. However, there is increasing concern that the current system for training doctors following graduation from medical school falls short in terms of producing an adequate workforce to meet the nation's changing health care needs. Reforming the graduate medical education system will require accurate data on the true costs of training physicians, greater oversight and accountability, and a transition from the current outdated financing system that is based mainly on federal support to a system that is more equitably distributed among stakeholders and where the funding is controlled by the states and follows the trainee.
(The Heritage Foundation, December 29, 2014)

Health Care Services Gap Narrows between Whites and African-Americans
A University of Pittsburgh study has found that nationwide disparities in the quality of hospital care between whites and minorities have decreased for those with acute myocardial infarction, heart failure and pneumonia. The Pitt study, "Quality and Equity of Care in U.S. Hospitals," showed progress from 2005 to 2010 with "increased racial and ethnic equity" for hospitalized African-American and Hispanic adults, as compared with white patients. Reductions in disparities between race and ethnic groups resulted from "more equitable care for white patients and minority patients treated in the same hospital," and "greater performance improvements among hospitals that disproportionately serve minority patients," states the study, led by Michael J. Fine, a professor of medicine at the Pitt School of Medicine. The study also involved researchers from Brown University, the Centers for Medicare and Medicaid Services and various veteran health centers. According to the study, "Equity is a key dimension of health care quality. Therefore, efforts to gauge progress in quality of care must include explicit considerations of whether gains have also occurred in health care equity." ( Pittsburgh Post-Gazette, December 30, 2014)