Alignment Efforts Can Improve Quality, Reduce Costs
Efforts focused on restructuring payment to reduce fragmentation and counter volume-driven incentives of the current fee-for-service program can both improve quality of care and reduce costs, according to Janet Corrigan, PhD, president and CEO of the National Quality Forum. Such efforts include increasing dollars at risk under current pay-for-performance programs, developing chronic condition coordination payments, and providing payment for patients to receive educational decision aides.
Payment systems that could potentially foster more substantial alignment of hospital and physician interests include creating bundled payments across providers over time through such means as episode-based payments for hospitalized patients, episode-based payments for chronic care patients to accountable health entities, and outcomes-based payments.
Even under the current payment system, hospitals need to take steps to improve alignment with physicians. “Physician-Hospital Alignment: Maximizing Collaboration and Minimizing Subsidizations,” one of the sessions featured in HFMA’s Chicago Fall Seminar, Dec. 7-9, addresses two areas crucial to these relationships: joint venture arrangements for ambulatory services and the structuring of strong, collaborative physician employment agreements to achieve both mission and budgetary goals. Learn more about the seminar.
HFMA and IHI Create Healthcare Financial Management Track at Forum
Given the critical importance of quality, outcomes, and process improvement, HFMA has worked with the Institute for Healthcare Improvement (IHI) to highlight sessions of interest to financial executives at IHI’s Annual National Forum (December 6 – 9, Orlando, FL). These sessions comprise an HFMA track which can be found on the Forum site.
In addition to these sessions, Richard L. Clarke, HFMA President and CEO will be moderating a special interest breakfast, “Linking Financial Management with Quality: A Roundtable Discussion Hosted by HFMA and IHI,” at IHI’s National Forum. Get more information here.
The ACE Demonstration: A Model for Payment Restructuring
One example where payment restructuring already is taking place is the acute care episode (ACE) demonstration. Hospitals and physicians participating in the project receive global payments for acute care episodes within Medicare fee-for-service for select orthopedic and cardiovascular inpatient procedures.
Incentives for participating hospitals include the opportunity to work with motivated physicians to improve quality and reduce waste and recognition as a Value-Based Care Center, which could potentially attract more patients to these high-quality, low-cost services. Physicians also have strong incentives, with potential to improve clinical pathways, the option to participate in gainsharing, a structure to support improved collaboration with other medical disciplines, and the opportunity to be “at the table” when systems are being designed to drive quality and efficiency.
Denver’s Exempla Saint Joseph Hospital is participating in the ACE demonstration for certain cardiac services. Debbie Welle-Powell, vice president of payer strategies and government affairs for Exempla Healthcare, admits the project start-up has been costly and a lot of work. However, the organization is excited by the opportunity to enhance its quality mind-set and the market recognition to be gained.
Welle-Powell’s presentation from the thought leadership retreat includes the hospital’s time line for implementation of key tasks, an organizational chart demonstrating physician and hospital reporting relationships, a flow chart of the ACE billing and payment process, and a step-by-step outline of the hospital’s gainsharing protocol.