Reporting and rewarding quality at the service level instead of the hospital level may accelerate improvement, according to a Health Affairs blog post.
Authors Dan Krupka, PhD, managing principal of Twin Peaks Group, and Warren Sandberg, MD, PhD, chair of anesthesiology at Vanderbilt University Medical Center in Nashville, Tenn., describe a new model for motivating quality improvement.
The model, called facilitated quality competition, relies on transparency of risk-adjusted outcomes and a mandate that payers steer patients to services, not hospitals, that provide average or better value. The authors recognize the unlikelihood a single hospital in a region will deliver the highest value for all services. By requiring hospitals to publish outcomes and bundled prices for a set of common procedures, which will then determine payers' patient steering, competition will spur quality improvement, according to the blog post.
The facilitated quality competition framework attempts to reward high-quality service lines with increased patient volume, as the negative relationship between quality and length of stay may create a disincentive to improve outcomes.
While this proposal presents several challenges, including the establishment of service line- rather than hospital-level contracts, the authors maintain that this approach may be superior to the value-based purchasing program. "We believe — provided that rules are observed — the institution of this Darwinian policy will lead to more rapid improvement in quality than VBP, which, in effect, leaves hospitals to struggle with excess capacity," they wrote.
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