Last week, healthcare providers got more big doses of the Obama administration's prescription for improving quality by tying Medicare payments to performance. It still isn't going down easy.
Of the hospitals that Medicare will penalize in 2016 for having the worst performance on measures to prevent patient harm, more than half are on the list for the second year in a row.
And for the first time, the CMS published quality performance scores for individual physicians, but only for those who volunteered data. Only about 6 in 10 are included. According to the American Medical Association, which criticized the agency for posting incomplete data, that's because many physicians gave up after struggling with the submission process and trying to correct inaccuracies.
Under a provision of the Affordable Care Act, Medicare reduces payments by 1% for the lowest-performing quartile of hospitals, meaning 700 to 800 U.S. hospitals will get dinged each year. The program is expected to reduce Medicare spending by $364 million in 2016.
“Our goal is for all hospitals to improve,” and roughly half did improve enough to escape the bottom quartile, said Dr. Patrick Conway, the CMS' deputy administrator and chief medical officer.
Critics of the program say many hospitals will have trouble climbing out of the bottom of the heap because the measures' risk adjustment fails to reflect that poorer and sicker patients are more likely to have complex medical conditions and experience adverse events.
Average scores improved on central-line-associated bloodstream infections and a composite index of eight measures of eight conditions, including pressure ulcers and sepsis.
Dr. Ashish Jha, a Harvard University health policy professor who has studied the program, questioned the progress on the composite index, which he said might have been the result of better recordkeeping by hospitals. “There is little reason to believe that care has gotten better,” Jha said.
The newly posted data on individual doctors score their performance on routine screenings and preventive care for common chronic conditions such as heart disease and diabetes.
Doctors who fail to report the 2014 data face a Medicare penalty in 2016.
“We heard from consumers that they wanted both group information and individual physician information,” Conway said. “We need to continue to push to accelerate the pace of change and improvement.”