Not all patients are made the same yet all hospitals are expected to achieve the same outcomes. Value Based Purchasing provides incentive for hospitals to have patients achieve specific outcomes in relation to infections, mortality, readmission and a number of other key measures. All hospitals have money held back by Medicare and then when the results are in the money is paid back to hospitals across the country depending on their performance. If a hospital performs at the national average they get enough money back to be whole, if they do better they get more money than they would have and if they perform below the average they get paid less. That’s a very basic description of a very complex process but you get the idea.
The problem with the program is not all patients are the same and socio-demographic factors are not taken into account. GVMH performs very well on national quality measures so we haven’t been penalized but an argument can be made that it’s more difficult for a hospital like GVMH to perform well than it is for a hospital that sits in a suburban setting with a highly affluent patient population.
I recently posted a blog about how education level has a direct impact on health. It’s not a secret that socioeconomic position does as well. Someone that can afford additional health related services not covered by insurance has a health advantage over someone who can’t afford those same services. Access to services impacts health as well and an individual who lives in a community with ready access to specialty providers has a health advantage over someone who lives hundreds of miles away from a specialty provider so geography can impact health outcomes as well.
Pay for performance measures are the same for every hospital regardless or location or economic status. Factors outside the control of a doctor or hospital – patients’ income, housing and education – can significantly affect patient health, healthcare and in turn a providers pay for performance. Providers are increasingly being paid based on quality criteria and those caring for the disadvantaged are being unfairly penalized. There is concern that if quality measures used to determine pay for performance are not adjusted to consider a patient’s socio-demographic status then the system will create disincentives to care for the poor.
There is some talk about leveling the playing field for providers. There is a two-year study being conducted by the National Quality Forum to determine if socio-demographics have an impact on patient outcomes. The study will provide real data that CMS can use to reevaluate the playing field and determine if the fence is the same distance from the plate for all hospitals.