It may be that some types of needless services would be avoided, like an expensive MRI that duplicates one recently performed. But the concern Jha points out is that in their efforts to be more judicious about what services patients receive, providers may go overboard and restrict other services for patients who might have benefited from them.
"Imagine there's a hospitalized patient who would really benefit from rehab. If a hospital said, 'Oh, that's going to make our efficiency measure look worse,' you can worry that patient won't get sent to rehab. They won't get a lot of post-acute care services that are helpful to them."
The problem is, there [is] no measure except mortality to gauge quality of care post discharge, Jha says. "If we're going to do a policy like this, where we're going to start measuring cost in the outpatient setting, beyond hospitalization, then we really need to measure quality beyond hospitalization too."
"We should have measures that assess functional status and outcomes from care. We shouldn't be doing one without the other."
All of this is new to hospital providers, some of whom are hearing about efficiency scores for the first time.