In post-acute rehabilitation, the measurement, capture, analysis and reporting of outcomes have a 25 year history. It has established a precedent for industry comparison of provider performance to drive improvement within the rehabilitation sector. Better than, worse than, or equal to others references how one is doing when matched against one’s peers in areas of agreed measurement.
This is good, right?
We must ask, “what has changed over the history of rehab outcomes reporting?” And while we take personal pride in looking back upon what we have learned, providers are hard-pressed to offer evidence to support the fact that quality or cost has been favorably influenced by these efforts. Many changes have occurred during the 25 years but most have been a result of payment or regulatory change. The pursuit of quality has never been a financial objective so there was no incentive to do anything different. If financial benefit (or consequences) did not result from better-worse-the same rankings, it seems these outcome reports may have less that meaningful use. Of greater concern is the question, “why are rehabilitation hospitals missing from the current incentive programs promising recognition and rewards for exceptions performance?” Could it be the rehab sector has been measuring and managing the wrong outcomes for the past 25 years?
The answer could exist somewhere in the shifting expectations that providing care is no longer justified unless it is done with consideration of cost and effectiveness. Being a well respected provider is not a guarantee for success in the new world of healthcare payment. Demonstration of value will be required and its quantification will add new granularity and meaning to better-worse-equal to.
The Medicare Hospital Value-based Purchasing Program will feature:
- An incentive payment percentage, based on baseline and performance periods;
- A comparison to national and state Total Performance Scores;
- Performance metrics will include the reporting of Clinical Process of Care and Patient Experience of Care;
- Clinical Process indicators will measure performance over time and reward continuous improvement;
- Patient Experience dimension performance improvement scores will measure patient perception of delivery and effect of care against patient centric expectations;
- A hospital’s individual Patient Experience domain consistency score will quantify how the hospital’s performance varies over time.
Throughout history practitioners have performed and delivered care based upon what the payment system has paid for; there is no reason to expect this fact to change. Providers don’t create the economic reality they function within, they react and adapt to it. The economic incentives associated with the Value-based Purchasing Program will shift our focus from traditional outcomes to value metrics and we will succeed on new levels of performance.
We should anticipate a fundamental shift in the way we are reimbursed for the services we deliver and the amounts allocated for those services. Provider behavior will follow in the way the post-acute rehab provider treats and manages the highest-cost, chronically ill patients and where payers and patient seek treatment for those conditions. The use of advanced analytical and data tools to enhance efficiency and recommend the course of treatment with the highest likelihood of quality care and low cost will be the standard methodology to capture and report outcomes and value.
