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"We can tick off and achieve some of the quality metrics," Samitt says, "but that doesn't necessarily mean that we are delivering higher-quality care. For example, you can test mammography rates for women for screening, but that is not an outcome measure; it is a process measure." Overall, 86% of respondents "Agree completely" or "Agree somewhat" that the industry needs more measures that address outcomes rather than processes.
A considerable percentage of the respondents—41%—does not know whether value-based purchasing will have a positive effect on clinical quality, and an additional 19% say VBP will not improve clinical quality. Stephen L. Moore, MD, chief medical officer at Englewood, Colo.–based Catholic Health Initiatives, a system with 76 hospitals and other facilities in 19 states, suggests that the PPACA's reliance on process measures is the reason that so many are uncertain.
"There have been a number of studies in the literature for the process measures we are using. Improvements in those numbers have not led to reductions in mortality, complications, or any measureable movement in outcomes-based performance," Moore says. "The survey results suggest that a large number of people are concerned, as I am, that process-measure issues that we have been focusing on to date are not clear enough indicators for outcome improvements."
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