Obamacare alters the practice medicine by putting a stronger emphasis on adherence to government-determined measures of quality.
The Centers for Medicare and Medicaid Services (CMS) already offers hospitals financial incentives to report on their compliance with certain measures of care. These are posted on Hospital Compare, a site where, according to Kaiser Health News, “patients can shop around by putting in their zip codes and the website churns out a list of nearby hospitals, with detail on available services, care outcomes, patient satisfaction ratings and more.”
These quality indicators include some measures of outcome, but they overwhelmingly focus on measuring processes. A recent study by the University of Michigan looked at whether process measures actually indicate that higher quality of care is being achieved.
They found that they did not. The study looked at the outcomes of 352,052 surgeries at 2,189 hospitals and compared them to adherence to process measures reported by Hospital Compare. According to the authors, they “found little evidence of a consistent relationship between hospital compliance with processes of care and operative mortality rate.” Furthermore, they write that “currently available information on the Hospital Compare website will not help patients identify hospitals with better outcomes for high-risk surgery.”
What does this mean for Medicare patients under the new law? Obamacare goes a step further than simply requiring hospitals to report on their adherence to measures. Beginning in 2013, hospitals that treat Medicare patients will be reimbursed at different rates based on performance, measured using the same quality indicators on Hospital Compare. In light of studies such as the one highlighted above, this means that the new law will compel physicians to perform processes that do not necessarily benefit patients. Moreover, hospitals risk being compensated less for not adhering to the measures, though they may nevertheless be providing high-quality health care.
would see population-based study results applied to their individual situations despite their unique health conditions, their personal values, and their doctors’ experience. They would find themselves under the care of physicians restricted in their ability to exercise their best medical judgment to tailor care to their patients’ specific situations and preferences. These physicians would have more incentive to check the boxes on the automatic protocol lists that generate compensation than they would to act in the best interests of their patients. This would undoubtedly decrease the level of medical innovation and weaken the doctor–patient relationship.
Value-based purchasing in Medicare will alter reimbursement only under Medicare Part A, but from the legislative language, it appears that the way that hospitals treat all patients will be used to determine performance scores. This means that all Americans, not just seniors, will be affected. The negative consequences of compliance-focused medicine are numerous. To read more, click here.