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Cost of Measure Outweighs Benefit

When we choose to make intentional decisions, we take time to consider the big picture which includes risks, benefits, the impact of a taking action and the impact of not taking action.


Centers for Medicare and Medicaid Service (CMS) has proposed changes for Hospital Inpatient Prospective Payment System (IPPS) and Long Term Acute Care Hospital (LTCH) Prospective Payment System.  Change can be great and good, especially if burden is removed and the focus is on value. Intentional decisions in the healthcare world keep the patient front and center. 

CMS has a new agenda that includes price transparency and helping patients have the information they need to be active healthcare consumers. Yes, patients do care about cost and I believe it is ludicrous how the predominant response when asking about cost is, "we'll know when we send the claim." Generally speaking, healthcare providers and office staff are not attempting to estimate a patient's financial responsibility which really does create difficulty for consumers when trying to make a decision about where to go or if the procedure is affordable. It's so difficult that many offices require patients to be the ones to call their insurance company. Don't get me going on that... even a well-educated patient will have difficulty truly knowing financial responsibility. How the healthcare provider bills matters. The diagnosis code matters. The procedural code matters. Patients don't have that type of information at their fingertips nor do they know to ask the healthcare provider for billing details.

I tend to believe most patients initially worry about cost.... and then their next worry is "will I be better?" "If I do X, will my life be better? Will I be able to do more? Will I no longer have pain? How much longer will I live? What will my quality of life be?" Measures that focus on improving the ability to answer patient related concerns have so much value in patient centered care.

As I reviewed CMS proposed changes, this particular quote resonated with me.

Measures were proposed for removal if they were duplicative, “topped out” (meaning that the overwhelming majority of providers are performing highly on them), or excessively burdensome to report. The proposal was aimed at enabling providers to focus on tracking and reporting the measures that are most impactful on patient care.

It sounded pretty good initially. As I started to read the details in the table, my head nodding abruptly came to an end with this row.

Assessed for Rehabilitation

Cost of the measure outweighs the benefit of its continued use.

Patients lying around in bed are for sure more costly than the bit of time it takes to assess if patients are candidates for rehabilitation. Maybe I'm a tad biased... I know the good that rehabilitation professionals provide with regard to helping people live to the highest functional level possible.

We are humans. Every patient should be assessed for rehabilitation. Every patient. It seems that the reason this measure was included may have been due to healthcare providers forgetting the importance of rehabilitation. Rehabilitation fits in patient centered care because it addresses the second concern patients have.  I would like an explanation of exactly how the cost of the measure outweighs the benefit. I'd also like to know the risk of not including the measure. How many patients will have inadequate care? How many will have suboptimal function? How many will experience a decline? How many will experience an increase in their future care?

Until next time,


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