Value Based Purchasing and Health Care Reform

AHRQ Posts Small Grant IT Funding Grant Opportunity

AHRQ has posted notice of a small grant program for development of IT for quality improvement.  The AHRQ post describes the grant program as follows:

The purpose of this Funding Opportunity Announcement (FOA) is to support a wide variety of research designs in order to improve the quality, safety, effectiveness, and efficiency of health care through the implementation and use of health IT.  These designs include: small pilot and feasibility or self-contained health IT research projects; secondary data analysis of health IT research; and economic (prospective or retrospective) analyses of health IT implementation and use.  Through economic analyses estimates of health IT implementation and use costs and benefits will be generated.   

Research Areas.  This FOA is focused on three research areas of interest:

• Health IT to improve the quality and safety of medication management via the integration and utilization of medication management systems and technologies;
• Health IT to support patient-centered care, the coordination of care across transitions in care settings, and the use of electronic exchange of health information to improve quality of care; and,
• Health IT to improve health care decision making through the use of integrated data and knowledge management.

The entire grant announcement may be viewed at http://grants.nih.gov/grants/guide/pa-files/PAR-08-268.html 

Congressional Hearings regarding Quality Payments

On September 9th, 2008 the ranking members of the Senate Finance Committee conducted a hearing entitled "Improving Health Care Quality, an Integral Step in Health Care Reform".  A series of health payment industry leaders testified about the need to move forward the value based payment agenda.   Senators Grassley and Bacus are continuing the ongoing discussions in Congress about how to fix the Medicare system.  Senator Grassley stated "The way Medicare currently pays for health care certainly doesn’t provide incentives to improve quality. Today, the poor quality provider gets paid the same as the high quality provider. In some instances, the poor quality provider gets paid even more. In fact, the current system encourages a high volume of services instead of quality. It is just disgraceful to me that Medicare rewards poor quality care in many cases. And because many private health plans follow Medicare’s lead in how they pay providers, these flaws in Medicare spread to the entire system. "

Senator Bacus stated, "Medicare rewards healthcare providers based on the volume of services that they provide. The more patients they see, the more revenue they bring in. That’s regardless of the quality of care.  Most policy experts and healthcare providers recognize that we need to shift our focus onto
quality. We need to encourage better patient outcomes.  This effort would improve the health and longevity of patients. And improving patient outcomes should also help to reduce costs and rein in healthcare spending."

What is notable for the health industry from these continuing congressional hearing is that there is high level support for moving the Value Based Purchasing initiative from both parties.  Regardless of who may be elected in November it is a fair bet that these discussions will go forward since no other alternatives seem to have a champion. 

What is Quality Medicine?

There is one word in the value-based purchasing universe that seems so clear, but like art is in the eye of the beholder--Quality.  We all want and feel that we are entitled to quality medical care.  Measuring whether we are receiving (or delivering) quality medical care is not as simple as it sounds.  No one would quarrel with the concept that a primary element of quality is whether the the treatments given resulted in the patient's condition improving.  The real trick is measuring whether the financial and physical cost of the treatment to the patient or society is justified in a particular case.  How those determinations are made are the subject of intense research in government and private clinical settings.  An often over-looked aspect of quality medicine is (at least from the provider/professional side) the patient's perception of the care they received.  All of this points out that defining terms is a critical starting place in the development of a value-based purchasing system.