Q: What are the necessary ingredients for any successful quality incentive payment program?
A: One of our big concerns is that there are lots of regulatory obstacles to true integration, where you can design some of those payment structures in terms of gainsharing and also in terms of payment for high-level-quality performance. One of the concerns of the AHM is to make sure that as we pursue these new models of care that require high levels of integration, we also look at some regulatory relief.
The promise is that if we can integrate the delivery system, we can then get focused on improving care and then rewarding high-quality delivery of care. And that can come through incentive programs or pay-for-performance programs and things of that nature that can be worked out between the hospitals and the physicians.
Q: What can be done to reduce the rates of hospital-acquired infections?
A: The idea of CUSP is that you create teams and a culture on units that will then implement the evidence-based intervention—in this case, eliminating central-line infections.
Hospitalists can play a critical role in helping create that culture of mutual accountability at the team level [and] holding each other accountable to use the evidence-based techniques for, in this case, line insertion, or for any kind of safety intervention. I think eliminating infections is a goal that’s achievable. I think we have come to the understanding over the last five or so years that these complications are avoidable in many, many cases, and that it takes teamwork, communication, and use of evidence-based procedures to get the work done.
Q: What can be done to help reduce preventable hospital readmissions?
A: There are so many things that go into readmissions. And the issue is: What is truly preventable in terms of treatments within the hospital, the coordination of discharge, and aftercare followup? A lot of readmissions are related to social determinants of health. And those have to do with people’s ability to afford their medications, people’s ability to access care, people’s home environment, and things of that nature. It’s going to take an approach by hospitals on those things that are controllable in partnerships with the physicians. But for many, many readmissions, it’s related to other issues that we as a society really have to hold ourselves accountable to.
Q: Some critics have charged that the overuse of medical technology is helping to drive up healthcare costs. Would there be more of a role for hospitals in decision-making about the appropriateness of tests within a model like an ACO?
A: In an ACO, that’s a partnership between hospitals and physicians operating as one entity. So that’s the difference, because there, everybody is aligned to make sure that we deliver the most effective care. There’s going to be much more time spent on physicians ordering the most appropriate technology or treatments for that condition that will deliver value to the patient and to the payor of that care.
But that’s in a totally integrated system. Right now we don’t have that. So where the interests of the physicians may be different from the interests of the hospital and the intentions are not aligned, it’s very hard to get at talking about what’s the most effective care.
Q: Is there a measure that hasn’t received as much attention that you would like to see more focus on to help improve the quality or cost-effectiveness of healthcare?