ures between baseline and per-
than the withheld amount.
formance periods, as well as on
As is often the case, third-party payors
comparisons
will likely follow Medicare's lead. In fact,
with overall
some major insurers have already
quality scores
announced their intent to move toward the
culled
value-based purchasing reimbursement
from
model, says Mr. Shoemaker.
hospitals
GOAL ORIENTED
Medicare payments are
now linked to quality
reporting and meeting
specified quality measures.
across the
nation.
CMS is
linking surgery-related process
measures and patients' opinions
Can you measure quality?
The overall goal of the new quality measures is to ensure better patient care. But is
that possible? "CMS is trying to define quality, but no one has been able to adequately
define what it means," says Dr. Shapiro.
of the care they received to hos-
"How do you devise accurate measure-
pital quality reporting in 2013
ments reflective of quality, or degrees of
(see "Key Hospital Quality
quality?" He concedes performance meas-
Measures"). It funds the valuebased purchasing program with 1% of
inpatient revenue collected from every
hospital, then pays portions of the sum
ures let individual facilities make better
healthcare decisions, but questions
whether financial penalties should be
attached to clinical outcomes.
back to best performers at the end of the
Mr. Shoemaker supports quantitative
year. (The agency will increase the amount
measurements of quality performance. "But
withheld incrementally over the next sev-
what Medicare has done is emphasize stan-
eral years.) Hospitals performing below
dards that are believed to be best practice,
average won't get money back, average-
but are really measures where there's a lot
performing hospitals will break even and
of variability," he says. "Some hospitals are
top-performing facilities will receive more
doing very well, and some are performing
J A N U A R Y 2013 | S U P P L E M E N T
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