But how to measure? The AHA says that the Centers for Medicare & Medicaid Services "intends to achieve alignment of purpose by taking measures used in reporting programs for one setting and including them in another. However, this compromises the accuracy and credibility of measure results, making it difficult to determine whether improvements are being realized." Post-acute providers "urgently need measures of patient functional status, goal attainment, care coordination and cost that would allow them to engage with broader, cross-health care system improvement priorities."
What Premier and several other stakeholders in the acute care world want to see, he says, is a value-based purchasing system that spans the healthcare provider spectrum, similar to the value-based purchasing system for hospitals that's required by the Patient Protection and Affordable Care Act.
"We fundamentally think all of these ought to be in one value-based purchasing program, and that there shouldn't be a penalty program."
All providers, acute and post acute, would relinquish revenue for a revenue neutral pool of funds, out of which the best providers, those with the best total results from all quality measures, would share rewards.
"There may come a day when we don't have fee-for-service reimbursement, and it's all bundled payments or accountable care organizations," Childs says. "But as long as we do have fee for service, the only question is whether that fee for service has a quality component. And it's our firm belief that the system functions better if there is a level of quality measurement associated with it."