Orchestrating care Medicare beneficiaries receive outside hospital settings "falls outside the traditional boundaries of what hospitals have thought their job was supposed to be," Jha says. "And that's why I think the hospital industry has fought harder against this (efficiency measure) than it did against readmissions penalties. If I'm going to be held responsible for what services get received on day 15 or day 20 post discharge, from a cost point of view, I think you would also want to something around measuring the quality of that care."
Jha says that the issue hasn't boiled up much yet because hospitals and the physicians who work in them have not yet realized the impact high episode of care costs are going to have on their reimbursement checks. It's also a small impact at first, only 30 cents for every $100 of Medicare reimbursement. The financial incentives won't stay small for long.
"I would not be surprised if the efficiency measure plays a bigger and bigger role (in value-based purchasing) as time goes on," Jha says. "This is a place where there may be some real savings for the Medicare program."
Jha reflects back to a time just around the healthcare reform debates. "I used to hear this non-stop chorus from CMS officials, that if we only got more integration, and the world looked more like Kaiser, it'll be great for healthcare spending and reduce healthcare costs.
"Now I think there's an increasing recognition that's not necessarily true. Maybe these are some ways of reducing some amount of Medicare spending, but on the private insurance side, it's going to make some things a lot worse."