Experts consider increasing diversity among doctors, nurses and other professionals as essential to reducing costly, debilitating health disparities among U.S. minorities. Now, the CMS may give hospitals added incentive to bolster their efforts.
The agency’s bid to tie physician and hospital pay to performance could incorporate a focus on health disparities in the next few years, says Barry Straube, the agency’s chief medical officer and director of the office of clinical standards and quality. The CMS launched its pay-for-performance effort among U.S. hospitals in 2003 and followed by unveiling a pilot list of physician measures in 2006, which the agency expanded to 74 criteria for 2007. Straube, who discussed the fledgling plans at the National Minority Quality Forum’s annual leadership summit in Washington in April, told attendees that the agency is considering how to use its purchasing power—$588 billion in fiscal year 2006—to improve minority health.
In an interview, Straube says the initiative is in early stages and it faces a significant preliminary hurdle: spotty data on patients’ race, ethnicity and language. Straube says incomplete or unreliable data on patients’ race and ethnicity has long been acknowledged as an obstacle to targeting disparities. Armed with data, providers can better identify and target treatment for underserved patients, he says. Hospitals’ efforts to collect such information varies, an August Commonwealth Fund report noted, and CMS does not require disclosure. Meanwhile, some patients fear releasing race and ethnicity information will lead to increased discrimination.
Architects of federal quality incentive efforts must also consider how pay-for-performance could inadvertently worsen care for patients with complicated or severe illness, including underserved minorities, he says. That could be the case if incentive schemes don’t offset the extra costs associated with caring for the most intense patients.