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VBP Incentives Put Process Measures to the Test

Cheryl Clark, for HealthLeaders Media, July 13, 2011
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When the Obama administration released final rules on value-based purchasing incentive payments in April, many hospital and physician leaders braced themselves for uncharted waters.

Starting this month 70% of the score that 3,500 hospitals will be judged on for federal dollars will be based on how well those facilities perform 12 process measures, steps for which there is some evidence—but sometimes little hard proof—that these tasks correlate with true outcomes, such as saved lives or reduced readmissions. 

Consider:
  • It makes sense, for example, that giving prophylaxis avoids venous thromboembolism in surgery patients.
  • It’s presumed to be a good thing for a provider to collect blood from a pneumonia patient before giving antibiotics because if blood is taken afterward, a false negative result is possible. But what effect that has on pneumonia survival is unclear.
  • And it’s deemed important to give congestive heart failure patients discharge instructions so they’ll know how to stay healthy when they get home. But whether those instructions improve the patient’s posthospital diligence may depend on how carefully the message is explained and whether it is understood.

Nonetheless, VBP means providers will be making sure they complete the required processes. 

“The train has left the station,” so there’s no turning back now, says Kenneth Kizer, MD, founder and former CEO of the National Quality Forum, which has endorsed nearly all of the measures in the final VBP rule. But even he agrees there are troublesome disconnects between process measures and outcomes, between the processes being tested and mortality.

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