CMS Plan Would Tie Efficiency Scores to Hospital Payments

Cheryl Clark, for HealthLeaders Media , May 2, 2012

"The end result is a lack of national data that hospitals can use to verify CMS’s calculations, determine the appropriateness of the methodology or analyze true differences in performance."

Concerns over quality
Nancy Foster, vice president for quality and patient safety for the American Hospital Association, said in an interview, "We need to pull (the measure) apart and figure out what it is beginning to tell us. And unfortunately, the downloadable file on Hospital Compare does not contain all the detail one would need to more effectively understand what's going on in each of these communities.

"The question in my mind (for those hospitals) at the low end of the scale," Foster continues, "is are those patients able to access all the services they truly need? Or are we seeing very low costs in some cases because patients aren't getting all of the services they need? I think we don't know."

She adds that since these cost variances are being released for the first time, "we need to kick the tires on these measures." She notes that "It seems to me challenging to assume that a patient could get all the care they need (at one hospital in one part of the country) at a cost that's one third that" at a hospital somewhere else.

"I, for one, am looking forward to the plethora of researchers who begin to slice and dice this data and tell us what they're seeing."

Foster predicts that communities will certainly look at patterns. It may be that a community with lower costs uses rehabilitation services or other post-acute care services as their "secret sauce of success," to get patients well on their way to recovery earlier after hospitalization, she said.

"In coupling these payment measures with the quality measures, I think we'll truly begin to learn where the sweet spot is here," she said. "How do you put together this cadre of services where you get high quality good outcomes with the lowest possible cost?"

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