posted 11/06/02
The National Academy of Sciences said today that
Medicare, Medicaid and other government programs should reward high-quality
health care by paying higher fees or bonuses to the best doctors, hospitals,
nursing homes and health maintenance organizations.
In a report requested by Congress, the academy
said that the federal government should establish standard measures of quality,
assess the performance of each health care provider and publish comparative data
for use by consumers.
The report, by the academy's Institute of
Medicine, said that after years of fitful, disjointed efforts, the government
must use its leverage as a buyer, regulator and provider of care to upgrade the
quality of services received by 100 million Americans in six federal programs.
Dr. Gilbert S. Omenn, professor of medicine and
public health at the University of Michigan, who was chairman of the 17-member
panel that issued the report said that, "The federal government should take full
advantage of its influential position to set the quality standard for the entire
health care sector."
One way to do this, Dr. Omenn said, is to link
pay to performance. Health care providers achieving "exemplary levels of
performance," as measured by government criteria, might receive 5 percent to 15
percent more than the standard payments, the panel said.
The academy issues dozens of reports each year,
and many generate little response. But the recommendations today are likely to
produce results in the near future, because Congress, employers, insurers and
many health care providers are receptive.
Tommy G. Thompson, the secretary of health and
human services, welcomed the new report, including its call for standard
measures of performance. But he did not say whether he agreed with the proposal
to reward high-quality care with higher payments.
In the report, the institute proposed an
ambitious schedule:
In the next two years, the government should
issue standards to evaluate treatment of 15 common health conditions, like
diabetes, depression, osteoporosis, asthma, heart disease and stroke.
By 2007, doctors, hospitals and other other
health care providers in the six federal programs would have to submit data to
the government showing how they treat patients with any of the 15 conditions.
Starting in 2008, each federal program would
publicly report data comparing the quality of care available from health care
providers who treat its patients.
The recommendations assume that doctors and other
providers will take major strides to computerize medical records, perhaps with
tax credits and other federal incentives for the purchase of information
technology.
Under the panel's recommendations, Dr. Omenn
said, health care providers would have to submit "audited patient-level data,"
and it makes no sense to cull such information from paper medical records and
insurance claim forms.
The six programs in question are Medicare and
Medicaid, for the elderly, disabled and poor; the Children's Health Insurance
Program; the Defense Department's Tricare program, for military personnel and
their dependents; the veterans health program; and the Indian Health Service.
Hospitals and doctors endorse the goal but
question some of the details. Elisabeth Belmont, corporate counsel for Maine
Health, which operates seven hospitals, a nursing home and a home health agency
in Maine, said plaintiffs' lawyers could argue that any deviation from the
"minimum standards" constitutes negligence, showing medical malpractice.
Source: Diabetes In Control Dot Com.
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