While approaches to public insurance options and health exchanges have dominated the discussions of the House and Senate healthcare reform bills, issues addressing quality and value have been threaded through the bills, sometimes matching each other, sometimes showing some differences in the individual bills.
Here are some examples:
Medicare and Medicaid Payment Innovation Center. Both the House and Senate bills would require the Centers for Medicare and Medicaid Services (CMS) to develop and test innovative payment and care delivery models that emphasize coordination of care, quality improvement, and efficiency. These would include patient-centered medical homes, accountable care organizations, and bundled payments for hospital acute and post-acute care. The Senate bill also would implement a national, voluntary shared savings program for accountable care organizations.
Healthcare associated infections. Under the Senate proposal, hospitals with high rates of hospital acquired infections would have their Medicare reimbursement rates cut by 1%. In the House bill, hospitals and ambulatory surgical centers would be required to report public health information on healthcare associated infections to the Centers for Disease Control and Prevention.
Patient Centered Outcomes Research Institute. The Senate bill calls for creation of an independent, nonprofit institute governed by public and private sector representatives to provide for research designed to "inform the decisions of patients and providers" regarding the clinical effectiveness of different medical treatments and services available for the same condition.
The Agency for Healthcare Research and Quality would disseminate research findings from the Institute and other government funded sources.
Value-based purchasing. In the Senate bill, Medicare payment policies would promote quality outcomes, including hospital and physician value based purchasing and incentives for quality reporting and improvement for all Medicare providers.
Quality improvement in private health plans. The Senate bill would require plans offered in a state health exchange to reward quality by including payment incentives related to quality reporting, case management, chronic disease management, prevention of avoidable hospital admissions, improvement in patient safety, and promotion of wellness initiatives. Health insurance plans in the exchange would be required to limit contracts with hospitals with more than 50 beds to those with patient safety evaluation systems and comprehensive discharge planning programs.