Commercial health insurers and self-insured corporations seem to be waiting for CMS to scrap its current Medicare provider reimbursement system in favor of one that rewards quality before doing the same, the president of the nation's largest accreditor of hospitals and health systems says.
"Quite frankly, everybody's looking at the big payer," says Dennis O'Leary, M.D., president of the Oakbrook Terrace, Ill.-based Joint Commission on Accreditation of Healthcare Organizations. "If Medicare starts paying for quality, the business community will start moving very quickly."
O'Leary made his comments Monday at the Healthcare Information and Management Systems Society's summer conference in Chicago.
The business community has shown its desire to improve healthcare quality via the Leapfrog Group, a consortium of major healthcare purchasers.
Jonathan Teich, M.D., CMO of the HEALTHvision informatics subsidiary of Irving, Texas-based hospital purchasing cooperative VHA and a participant in Leapfrog Group discussions with healthcare providers, says that Leapfrog has been talking to CMS to develop quality goals for ambulatory care.
"CMS should and has been looking into how it can get (ambulatory quality measures) into its payment system," Teich said at the HIMSS meeting Monday.
JCAHO and Leapfrog are among the healthcare quality advocacy groups that met last fall with representatives of CMS, the Agency for Healthcare Research and Quality, the Department of Defense and other federal agencies that pay for healthcare to try to make a business case for quality improvement, O'Leary says.
Although the federal officials were receptive to the idea, O'Leary says the healthcare community still has "a major problem with our largest payer (Medicare) and those other payers that follow."
According to O'Leary, "Those who invest in technology for patient safety interventions are not the same as those who reap the benefits of patient safety interventions."
CMS has proposed testing a Medicare pay-for-performance system on a pilot basis with hospitals in the Premier group purchasing organization, but otherwise has not announced plans to move away from its traditional policy of paying for services regardless of outcomes.