Why Process Measures Fail to Budge 30-Day Mortality Rates
The recent Harvard study that debunked Medicare's largest pay-for-performance program with the "sobering" conclusion that the project's process measures failed to reduce 30-day mortality has prompted many thoughtful healthcare providers to wonder anew:
Are we using the best process measures of care to save lives? Or are we just measuring how well hospital teams perform on relatively less important tasks? Are we forgetting or ignoring much better measures, such as in heart care, that are more solidly linked to better outcomes? Or are we just slow to adapt what we know about good care to public policy?
Those are pretty darn important questions because a six-year, 252-hospital pay-for-performance program, the Hospital Quality Incentive Demonstration that ran under Medicare's contract with Premier Inc., was the model for the value-based purchasing quality incentive program, which soon will redistribute reward money to hospitals from a pool of $850 million.
Cardiac Care Concerns
For heart care especially, the answer to the questions above is an adamant "yes," says Gregg Fonarow, MD, Director of the Ahmanson-UCLA Cardiomyopathy Center. In an interview last week, Fonarow listed six measures proven to reduce mortality, which the Centers for Medicare & Medicaid Services and the Joint Commission are not using to evaluate hospital care today.