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.
