Quality Care: Fee-for-Service or Data-Driven Reimbursement?
By - Financial reform efforts require alignment to reward quality over volume within the realm of health information technology (HIT), confirms a recent report published by Aziz Sheikh, MD, Harpreet S. Sood, MD, and David W. Bates, MD (Sheikh, et al) within the Journal of the American Medical Informatics Association (JAMIA).
The authors conducted 47 interviews between November 2013 and July 2014 with a variety of healthcare professionals, including physicians, healthcare providers, and payers, to garner deeper insight into how technology usage and implementation within the industry is curtailing costs while advancing industry-wide quality of care.
Promoting the adoption and meaningful use of health information technology (HIT), The Health Information Technology for Economic and Clinical Health (HITECH) Act, established as part of the American Recovery and Reinvestment Act of 2009, became law in February of 2009.
According to Sheikh, et al, the HITECH Act stems from a concentration of policy beliefs that HIT and the data surrounding it actively maintain and reinforce current healthcare reform efforts. Following economic collapse, there was an outpouring of federal financial investments within the HIT realm of the healthcare industry, maintain Sheikh, et al.
One of the recent primary objectives within the healthcare industry, Sheikh, et al, confirm is to reduce overall healthcare expenditures. Following Meaningful Use implementation, HITECH execution became more widespread via the administration of financial incentives, they maintain.
There are a variety of Electronic Health Record (EHR) usability concerns that resultantly hinder interoperability, Sheikh, et al, explain. When technological issues hinder revenue cycle management, the overall quality of patient-centered, value-based care is weakened.
There are three primary concerns that require addressing, say Sheikh, et all. One is that EHRs are unable to support billing insurance documentation. Second, EHRs are also primary optimized for simple transactions which limits their effectiveness. Third, EHRs do not collect data that allows healthcare providers to effectively measure quality. The three aforementioned dilemmas were apparent both between healthcare providers operating within different health systems and among providers working within the same health system, state Sheikh, et al.
Despite the existence of these tangible challenges in usability and data exchange, Sheikh, et al, found a digitized infrastructure does help achieve cost savings while advancing the quality and safety level of patient care.
One strategy for achieving cost savings includes discontinuing treatments if there were associated medication safety concerns.
An additional strategy to achieve such goals involves switching patients to cheaper alternative medications. As one interview participant in the JAIMIA study stated in reference to administering patients cost-effective generic angiotensin receptor blockers (ARBs), “We looked recently at how money we would save if we just got all of the people who were getting brand name ARBS moved over to the one generic ARB and it was a million dollars a year for one drug class.”
Regarding additional collective efforts to reduce expenditures while improving care quality, a widespread affirmation from those healthcare providers interviewed confirmed more attention needs to be placed upon enabling population management under Accountable Care Organizations (ACOs).
As one healthcare expert commented, “Today [the] majority of care is chronic care but health systems still built around reimbursements for diseases that took care almost 100 years ago.”
In relation to this idea, another healthcare professional stated, “There is value to end the Meaningful Use program by rolling it into the various pay-for-performance or merit-based performance payment programs of CMS.”
A movement to eliminate fee-for-service initiatives within the healthcare industry is holding ground, say Sheikh, et al.
“Achieving the wholesale financial reform called for by many participants was thought an unrealistic proposition in the near-term by those most familiar with the policy landscape,” state Sheikh, et al, who promote the advancement of incremental steps intended progressively phase out fee-for-services. Sheikh, et al, advocate the healthcare industry would benefit by the replacement of fee-for-service with risk sharing models that reward provision of high-quality care.
Regarding the overall implications of their conducted interviews, Sheikh, et al explain they found comprehensive consensus among a range of experts that HITECH exactly achieved its core aim of promoting adoption of EHRs into the hospital and ambulatory sectors.
“Our data indicate that while this digitized infrastructure is now being used to stimulate healthcare reform efforts, a number of major obstacles need to be overcome in order to fully realize the potential of HIT and capitalize on the investments that have been made,” confirm Sheikh, et al.
Many of the healthcare providers interviews emphasized a desire to “kick the legs from underneath the fee-for-service model” and replace it with a data-driven reimbursement system that rewards high quality care, say Sheikh, et al.
“In particular, experts highlighted the need to stimulate competition in the vendor marketplace, develop a coherent national policy to promote HIE and interoperability, and, wherever possible, align policy initiatives in relation to HIT with financial and structural reform efforts in order to reward quality rather than volume of care,” maintain Sheikh, et al.
Although the HITECH Act has successfully stimulated unique, multi-stakeholder HIT concentration, the subsequent digital infrastructure is improving quality of care and keeping costs low, conclude Sheikh, et al.
“Reform efforts are however severely limited by problems with usability, limited interoperability and the persistence of the fee-for-service paradigm — addressing these issues therefore needs to be the federal government’s main policy target,” Sheikh, et al maintain, who confirm the computerization of health records will help reduce costs and decrease the per capita expense within the healthcare industry at large.
Sheikh, et al, advocate a push for immediate innovative policy initiatives, such as rewarding all aspects of avoidable usage via pay-for-performance models to keep costs advantageously minimal.
