Quality improvement in an era of change

Special to Medical Journal – Houston BY TED SHAW, President/CEO, Texas Hospital Association

Zero harm and the best quality health care have always been the hallmarks of Texas hospitals’ work.

In recent years, public and private payers have increased the use of financial incentives and penalties to accelerate hospitals’ quality and patient safety initiatives while also reigning in costs.

According to the Centers for Medicare & Medicaid Services, per capita health care costs reached more than $10,000 last year, and health care spending consumed almost 20 percent of the nation’s gross domestic product.

Quality measures and public health outcomes trail behind those of other developed counties, and despite significant coverage gains, about 28 million Americans—9 percent of the population— still lack health insurance.

Providers and consumers alike can recognize that fundamental changes are needed to make the U.S. health care system work better, but reconciling what changes are needed, who is responsible for those changes and which reform efforts are most promising is no small task.

The shift to a payment system that rewards insurers, hospitals, doctors and other providers for high quality, efficient clinical care is still a work in progress.

The federal government’s plans to implement sweeping Medicare payment reforms were disrupted by multiple efforts to repeal the Affordable Care Act.

CMS eventually canceled the ACA-required implementation of the Medicare bundled payment programs for heart attacks, bypass surgeries and certain joint replacement surgeries. Under the now-canceled bundled payment programs for heart attacks and bypass surgeries, hospitals would have been financially accountable for the cost and quality of all care associated with heart attacks and bypass surgeries. If implemented on the intended Jan. 1 start date, the cardiac payment models were estimated to save Medicare $160 million over five years.

Other value-based purchasing programs are also facing scrutiny, including the hospital readmissions reduction program and the merit-based incentive payment system created under the Medicare Access and CHIP Reauthorization Act of 2015.

Yet, while the movement towards rewarding value isn’t a straight path, progress is being made toward improving health care quality.

The Texas Hospital Association supports the state’s nearly 500 hospitals and health systems in their quality and patient safety work by leading initiatives that help hospitals collect, analyze and more effectively use their data and engage them in quality improvement initiatives to improve patient outcomes.

From reducing hospital-acquired infections to reducing avoidable readmissions, THA currently works with 350 Texas hospitals on numerous state and federally sponsored clinical initiatives, which are yielding impressive results and better patient care.

While this work continues, new bundled payment opportunities are emerging. CMS’ new Bundled Payments for Care Improvement Advanced will align financial incentives for hospitals and physicians for 32 episodes of care for Medicare patients. Additionally, it will measure performance across seven quality measures, including hospital readmissions.

As the shift to value continues and takes on different forms, Texas hospitals will continue their well-established missions to provide the safest, best quality care to Texas patients.