Safety, Quality Measures in Health Reform
Posted 5-21-10
Healthcare reform employs various mechanisms to improve quality and patient safety. Among them:
- Doctors who participate in Medicare's Physician Quality Reporting Initiative will get a bonus of 1% in 2011 and 0.5% from 2012 to 2014. An extra 0.5% bonus is available to doctors who participate in their specialty board's maintenance-of-certification program. Starting in 2015, doctors who do not take part in PQRI will have their Medicare payments reduced 1.5%. The penalty will be 2% beginning in 2016.
- Public reporting of physician performance data starts in 2013.
- Hospitals with high readmission rates for patients with conditions such as heart failure will have their payments cut. The change takes effect in October 2012, with the conditions list expanded in 2014.
- The Department of Health and Human Services will start tracking hospital-acquired conditions such as pressure ulcers in October 2014 will reduce Medicare payments by 1% for hospitals whose harm rates are in the top quartile. The congressional Budget Office says the change will save $1.4 billion over 10 years.
- Medicare's no-pay policy for health care-associated conditions will be expanded to all state Medicaid programs. Starting in 2014, hospitals' record of cases for which payment was denied will be reported publicly.
- Hospitals that meet performance standards set by HHS on at least five quality measures will get a pay bonus from a pool of funds collected from all hospitals, starting in October 2012.
- A cost-quality index modifier set to take effect in 2015 will redistribute Medicare payments to physicians based on risk-adjusted measurements of quality and health outcomes.
- A CMS Innovation will experiment with different care payment mechanisms to tackle priorities such as reducing readmissions and improving chronic care management.
- A Center for Quality Improvement and Patient Safety will fund research into problems such as hospital infections, readmissions and intensive care, disseminating its findings to physicians, hospitals and the public.
Source: AMA; Consumers Union; House Energy and Commerce Committee; Senate Democratic Policy Committee