ACO Pioneers: Not So Fast
In February, the Centers for Medicare and Medicaid Innovation (CMMI) sent out the 31 proposed quality targets that pioneers would have to meet if they wanted to receive bonus payments. Bonuses would be based on their ability to meet those targets beginning in 2013. But then, last week, 30 of the pioneers sent a letter to CMMI complaining that at least 19 of the quality targets had too little data behind them and were therefore unfair, unreasonable and even arbitrary.
More on accountable care strategies in the Kaiser Health News blog.
The problem is: in establishing ACOs, the PPACA tries to create a mechanism that attempts to create the quality measures that would ordinarily come from competition. I don’t believe it’s actually possibly to force quality where the desire does not exist.
Quality in this sense would be arbitrary any way you look at it. The best quality stems from competition as organizations push the envelop on innovation in order to compete. Hence, a standard quality metrics would rely on competition, which may be useful for a certain standard under which care ought not to fall below, but not one to measure and incentivize quality.
Bonuses for quality? Poor data? This will clearly not work to improve quality care and instead it’s going to misallocate funds in the wrong places I believe.
It’ll be very interesting to see what happens to ensure that these “qulities” get up to par. Will the Pioneers comply?
If I were some inscrupulous pioneer, I would just arbitrarily make up numbers to get the dough.
This seems like another example of the government making regualations without any imput from the stakeholders it will affect.
“This is what federally run delivery system reform actually looks like: a lot of failure and frustration,” Need I say more?
The highlight of the article was “I think there’s gonna be a lot of closed door meetings and heated phone calls…But eventually, everyone will come out holding hands.” If this ever happens, only then will I believe unicorns exist, and Santa Clauss…
“I think there’s gonna be a lot of closed door meetings and heated phone calls,” said Johnson of Avalere. “But eventually, everyone will come out holding hands.”
This from the administration who won an award for transparency. At the ceremony that wasn’t advertised or covered by media.
It’s interesting that 19 of the percentage benchmarks have no anchoring methodology.
This is straight of the Hogwartz doctrine that dominates bureaucratic planning processes.
“‘Quality measurement is really hard,’ Dartmouth’s Elliott Fisher says. Fisher recently co-authored a major Institute of Medicine report on the issue, and says there’s no industry standard on quality measurement—but always lots of questions.”
So how exactly are we going to pay for quality if no one can figure out how to measure it?