3 Ways Hospital Value Based Programs Can be Improved
One of the biggest things that strikes me with most of the Medicare value based purchasing programs is the complexity of the program. The focus seems to be on reporting codes versus really focusing on what is truly desired for the outcome.
The only successful program I can think of that was packed with value for patients was implemented by the Institute for Healthcare Improvement. The 100,000 Lives Campaign was successful. The reason for success was due to the simplicity: only 6 very relevant items were the focus for a goal of saving 100,000 lives. Changing behaviors to focus on 6 items would directly lead to accomplishing the goal.
The three ways to improve hospital value based programs hinge on reducing the complexity of these type of programs.
1. Determine the real goal. Define the desired outcome. This could be as simple as a 40% reduction in current infection rate. It could be focused on changing clinical pathways. An example might be a 50% increase in current referrals to rehabilitation when in acute care. Providers all want to see a measurable difference actually happened. Providers will rally behind an effort that has real change.
2. Eliminate all reporting of measurements that do not pertain to the final goal or outcome. The reporting needs to be less burdensome for providers. Boatloads of required measurements dilute efforts.
3. There needs to be more skin in the game. If the desired outcome is achieved, the amount of incentivization needs to be more than a 1-2% incentive. Providers delivered the value to the patient AND saved the payer money. It's only reasonable to share the savings with providers. If the desired outcome is not achieved, the penalty needs to hurt a bit more.
In the rehabilitation world, FOTO has been integral in value based purchasing payment models. The power of a very large outcomes database that not only measures outcomes, but also predicts outcomes based on risk adjusted patient factors, allows for accurate comparisons of care. Patients desire care that allows them to reach their highest level of function in the shortest amount of time. That is the key data that matters.