Corrigan also cautioned executives and doctors in San Diego to be patient as an increasing number of dissimilar measures emerge from various specialty groups and organizations, which she acknowledges makes tracking, reporting and comparing performance tricky. Its going to be a little chaotic for a while.
In a Commonwealth Fund report released June 26, Davis, an economist, and two of the foundations policy experts called for Congress to establish a national quality coordination board, an initiative backed by the Institute of Medicine but missing from any federal legislative proposals, according to their analysis.
About 56% of respondents agree with the need for the new quality organization.
One respondent, Margaret OKane, president of the National Committee on Quality Assurance, stresses that no one strategy, including IT expansion, will suffice to improve healthcare quality, but she describes overhauling payment to providers as essential to making any gains. The payment system is going to have to change, so that you cant get by practicing 19th century medicine or management, she says.
OKanes views mirror nearly all survey respondents. Just 1% say fundamental payment reform is unnecessary. Forty-four percent say that pay-for-performance, touted by the CMS and many in the industry as a means of giving providers real incentives to adopt evidence-based medical practices, should be expanded.
An equal number of respondents say that it should be regarded as an important first step toward a more comprehensive payment overhaul. A quarter of respondents ask for an overhaul of reimbursement, but say that pay-for-performance strategies are an unnecessary distraction. Almost as many do not see quality incentives as helpful or harmful, but agree with the demand for significant changes to healthcare reimbursement.
As it stands, financial incentives reward healthcare for procedures and treatment, not efficient care, OKane argues. The current political interest in expanding coverage has sparked debate over cost, quality and efficient utilization, she says. There seems to be an understanding that quality and cost are not trade-offs. I just hope we can move forward.
OKane says she also considers financial incentives more likely than a Medicare mandate to win EHR adoption among Medicare providers.
Survey respondents favor financial incentives over voluntary industry measures as a strategy to improve healthcare quality. Two-thirds endorse a reward for Medicare beneficiaries who sign on for a so-called medical home, a regular provider who would coordinate patients interaction with the healthcare system. Nearly three-fourths say they support Medicare payment reform to maintain medical homes, including giving beneficiaries lower Part B premiums for using one.
Davis says the surveys support for medical homes, a national body to oversee and direct quality effortsas well as results that endorse further integration of solo and small physician practicesunderscores healthcare leaders understanding that national healthcare reform must mean more than merely expanding insurance coverage.
Its not just access, its access to what? Davis says.