Should CMS Get A Deal With Payer And Hospital Quality Partnership To Reduce Cost?

The pay-for-performance feature has been suggested by many medical industry experts who want to reduce the costs of running a facility. Right from the first point of notice to the end goal of a seamless medical billing and coding function, payer and hospital quality partnership will help in the long run.

The Centers for Medicare & Medicaid Services has endorsed such programs to improve the quality of care. To examine the state of quality initiatives endorsed by CMS, institutions, provider groups, and physicians shall be awarded incentives, based on adherence to composite metrics.

Slashing The Rising Healthcare Costs

Pioneering approaches to cut costs and improve quality are essential to slashing the high cost of healthcare for the American public. This is the right time to start partnering with payers on it. This is the view of two independent physicians and a registered nurse. They have recently authored an article in JAMA detailing the success of a Michigan program that is doing just that, which is reducing the overall cost.

The Michigan program, also known as the Value Partnership program is centered on procedural care that is primarily comprised of surgical services. This genre of care accounts for more than 50 percent of national healthcare expenses, said authors physician Daryl Campbell, registered nurse Greta Krapohl and doctor Michael Englesbe.

The program totally supported by Blue Cross Blue Shield of Michigan includes more than 3,000 surgeons practicing in 72 of Michigan’s biggest hospitals.

The authors attribute its success to several factors, but most importantly the physician-centric nature of the program. Doctors actually have substantial control over the quality metric design, priorities, and leadership.

They also push for innovation in medical billing and coding or even specialty billing with the goal is to improve care, not judge.

Reducing Costs Is Team Work Jumbled Between Surgeons And Hospitals Alike

Recognizing that physicians are motivated by their own sense of purpose, not just meeting performance targets, CMS should get a deal with payer and hospital quality partnership to reduce cost. Thanks to this unique mindset of Michigan medical facilities and physicians, no hospital has dropped out of the program since its inception 12 years ago.

The authors in their article attribute the success of the program to system-wide support from surgeons and hospital executives alike. Due to this move hospitals within the program have been able to form collaborative groups. Each group has its own procedural center, such as bariatric surgery, joint replacement, cardiology, or hysterectomy to name some of the focuses already at work.

Such groups have enabled fast and effective sharing of best practices and specialist information.

Breaking Down The Numbers

The Michigan Surgical Quality Collaborative involves general surgical and gynecological patients. The group evaluated more than 50,000 patients and found a reduction in overall complications from 13.1 percent to 10.5 percent over a five-year period.

The reduction in complications yielded a $20 million dollar savings for hospitals and payers over the said period. The same group developed a set of process measures to prevent surgical site infections after colon surgery. After evaluating compliance to those measures, results showed fewer infections and a “dramatic reduction in cost.”

In their summation as should CMS get a deal with payer and hospital quality partnership to reduce cost their view is: “These encouraging results demonstrate that hospitals in a statewide collaborative can derive recommendations from locally obtained data, implement them, and show improvements in both processes and outcomes.”

The other States That Have Similar Program

Other than Michigan, four other states have similar initiatives and the program could go nationwide if CMS would partner with payers to help absorb some of the costs.

The first state to do so would help the local methods of improving procedure quality and cutting costs, adding to its overall nationwide knowledge of such issues.

Also, since the program is an all-payer model, Medicare patients also benefit from the program, which according to the authors supports the assertion that CMS should pay a portion of the program’s operational costs.

So to answer the moot question as to should CMS get a deal with payer and hospital quality partnership to reduce cost, our answer is yes, with a big thumbs up. This would not help the common American people, but it will also, in the long run, streamline an entire billing function including specialty billing.