The Antidote

Counterspin for Health Care and Health News

Tuesday, December 12, 2006

This week in health care policy

The 109th Congress passed seven health care-related bills before wrapping up for the year, as summarized at Kaisernetwork's Daily Health Policy Report. According to AAAS' Center for Science, Technology, and Congress, the NIH Reauthorization Bill, HR 6164 increases NIH's budget by 5% for each of the next three fiscal years. It also creates a "common fund" for research that falls across different disease areas, or beyond the purview of individual institutes. Much of the health care quality improvement research I've written about could fall into this category, so with luck we'll see fewer such projects fall been the cracks.

Pay-for-Performance (P4P) is now a reality... or it will be as of July, 2007. One of the bills passed by Congress this session (HR 6408) gives physicians a 1.5% bonus just for reporting data on certain quality-of-care measures. According to Kaiser, Rep. Henry Waxman doesn't think federal officials know enough about how to measure quality to make P4P meaningful. The conservative Heritage Foundation, on the other hand, thinks it takes autonomy away from physicians. MedPAC, not surprisingly, wants docs to get a bigger cut for reporting.

I'd say elements of both criticisms are true, but both also lack nuance. The federal government actually has a fair amount of experience measuring quality, as evidenced by HHS' Hospital Compare; whether such measurement translates into improvement remains to be seen. Regarding Heritage, we know that when physicians are entirely left to their own devices, non-evidence-based care can result. However, requiring levels of 100% compliance for given quality measures can result in too much medicine, and also does not leave room for patient preferences as well as physician autonomy.

That's not the case with this bill, however, which is the easy part - it only involves the reporting of quality data. The achievement of particular levels of quality, though, is down the pike. Bottom line: proceed with caution.

The Institute for Healthcare Improvement, led by Don Berwick, on the heels of their 100,000 Lives campaign, has just launched their Protecting 5 Million Lives from Harm campaign. The goal is to encourage hospitals to implement straightforward reforms to improve patient safety by setting firm goals. One can quibble about the numbers achieved by 100K Lives (as the Wall Street Journal did, described and attached here), because while it's hard to pinpoint the cause of a death, it's even harder to attribute accurately the cause of non-deaths. As the WSJ article said, many people "admire [Dr. Berwick's] goals, but question his number." However, that campaign did engage 3/4 of the hospitals in the U.S., which is a success in and of itself. The new campaign, basically an extension of 100K Lives, will have an opportunity, one hopes, to mobilize hospitals to institute life-saving patient-safety measures and not present estimates of lives saved before the numbers are ripe (i.e., peer reviewed).


At 1:11 PM, Anonymous Anonymous said...

The Center for BioEthics at the University of Minnesota (I get their newsletter) has a researcher, David Satin, M.D., examining the ethical implications of Pay-for-Performance. He has an article about his work (The Impact of Pay-for-Performance Beyond Quality Markers – A Call for Bioethics Research) in the current issue:
In the article, Satin asks a series of questions about how P4P will affect access to care, patient centered-care, care for sicker patients, and the effect on clinicians.

--Dave Lewin


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