Gazette Opinion: Congress must change perverse payment incentives

2009-08-28T00:00:00Z Gazette Opinion: Congress must change perverse payment incentives The Billings Gazette
August 28, 2009 12:00 am

Buying health care isn't like shopping for most other things. We don't want to spend time in a doctor's office or hospital. We don't like to swallow pills or get injections. What we really want is to stay well - or get better health if we are sick or injured.

So it's curious that America's health care system pays hospitals and other health care providers not for making us well, but for the volume of prescriptions, tests, scans, procedures, hospital stays and office visits that our care professionals order for us. In the past several years, however, new ideas for transforming the system to focus on quality have started to get attention. The rewards of patient-centered care are being well-documented in research across the country, including projects involving the Billings Clinic and St. Vincent Healthcare.

As one of 225 U.S. hospitals participating in Medicare's Hospital Quality Incentive Demonstration Project since 2003, St. Vincent recently received awards for high-quality care.

Dr. Mike Schweitzer, chief medical officer for St. Vincent, explained how the demonstration project works. With hip and knee joint replacement, for example, the hospital looked at how many patients received appropriate antibiotics and medications to prevent blood clots. Protocols were developed to improve care, and then data were collected to measure improvement.

"Over the course of years, we have markedly improved care and we have sustained it," Schweitzer said. "Quality costs less. We're sort of ahead of the curve. We welcome health care reform."

In the four years ended Sept. 30, 2007, the 225 hospitals in the demonstration project saw about 4,700 fewer deaths among heart attack patients than they would have if they hadn't been in the program, the Medicare project contractor told The Wall Street Journal. This demonstration project is voluntary and has the support of the American Hospital Association.

Health care reform legislation should make such proven care protocols mandatory with financial incentives for good hospital performance and penalties for hospitals the fail to meet the care standard. Such requirements are in the best interests of patients and make the best use of health care dollars.

Billings Clinic is among 10 medical clinics participating in the Physician Group Practice project to measure how improvement in outpatient care can both benefit patients and reduce Medicare costs. For example, Billings Clinic demonstrated that having nurses provide daily telephone monitoring of congestive heart disease patients kept them healthier and reduced their hospital admissions. However, what was good for the patients resulted in a financial loss for the clinic because Medicare doesn't reimburse for the nurse monitoring but would have paid for the avoidable hospital stays.

In just one year, the third year of the Physician Group Practice Demonstration, participating clinics generated $33.3 million in savings for the Medicare Trust Fund, according to the U.S. Department of Health and Human Services.

No one involved in health care quality improvement is suggesting that providers be mandated to improve every service or to change their services immediately. Rather, change will take years of work. And standards of care should only be mandated where they have been proven to work well for patients.

"I think this is the wave of the future where there is good evidence," said Dr. Nick Wolter, Billings Clinic CEO.

Montana has long ranked in the lowest quartile for Medicare in beneficiary payments, Wolter noted.

"We receive less payment per service than other parts of the country," he said. Such geographic disparity, which has been extensively documented in the Dartmouth Health Atlas project, is one of the systemic problems that health reformers should address. Research has shown that in places where patients get higher volumes of tests and procedures, people aren't any healthier.

As a founder of Health CEOs for Health Reform, Wolter promotes the idea of moving away from traditional fee-for-service health care that pays for each unit of service, and thus provides financial incentives to boost the volume of service. In its stead, he advocates paying providers to deliver quality care.

Congress should start this important transformation by passing legislation this year that provides financial incentives for consistently high-quality Medicare patient care.

Copyright 2015 The Billings Gazette. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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