Core measures and value-based reimbursement responses

In responses to your peers, discuss the connection between value-based reimbursement and core measurement compliance. For example, you could address the following:

  • How have the organizations you are familiar with demonstrated core measures?
  • How do these results get reported?
  • Do you believe that achievement of core measures truly equates to value?
  • Do patients and consumers understand what core measures are?

Post #1 

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Ruth Kelly 

Core measures were developed with the intent of improving the quality of care delivery by creating a national standard of care for specific conditions.  These measures are periodically redefined based on evidence and performance (John Hopkins Medicine, 2020).  Healthcare organizations must comply with the recommended treatment pathways for certain medical conditions.  Compliance with core measures is reportable to The Joint Commission, as well as the Centers for Medicare and Medicaid Services, and other agencies (John Hopkins Medicine, 2020).  This information is used for the objective comparison of hospitals, as well as Medicare and Medicaid reimbursement. 

            Quality of care is driving the financial stability of healthcare organizations.  Hospital reimbursements through Medicare’s Hospital Value-Based Purchasing Program are adjusted based on the quality of care delivered as evidenced by compliance with these core measures (Centers for Medicare and Medicaid Services, 2020).  It is similar to saying that core measure compliance is synonymous with quality care and therefore, worthy of payment.        

            The shift toward a value-based purchasing system has caused healthcare organizations to adjust accordingly.  The financial implications for failing to do this can have detrimental consequences, especially for smaller independent hospitals.  Organizations like the Johns Hopkins Medicine have gone as far to develop core measure work groups in order to share, learn, and improve processes to increase core measure compliance (Johns Hopkins Medicine, 2020). They concede the value of collaboration in attaining their goal of becoming a national leader in core measure compliance.  Hospitals with fewer resources are finding it more difficult to improve measure outcomes and are instead focusing on improving their documentation of compliance with the measures (Early, Roberts, & Bonham, 2011).  So, even though incentive programs have been shown to improve measure performance (Early, Roberts, & Bonham, 2011), one might wonder if we are seeing an improvement in the quality of care, or just an improvement in documentation. Some say that future incentivizing may require deeper consideration (Early, Roberts, & Bonham, 2011).     

Reference 

Centers for Medicare and Medicaid Services (2020). Hospital quality initiative: Hospital value-based purchasing.https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/Hospital-Value-Based-Purchasing-

Early, G. L., Roberts, S. R., & Bonham, A. J. (2011). When core measures fail: How often has the patient received the prescribed care? Missouri Medicine108(3), 179–181.

John Hopkins Medicine (2020). Patient safety and quality: Core measures. https://www.hopkinsmedicine.org/patient_safety/core_measures.html

Post # 2

Ryan Reale posted Jan 5, 2021 2:38 PMSubscribe

According to Johns Hopkins, they define “core measures” as the national standard of care and the treatment processes for common conditions (John Hopkins Medicine, 2020).  Assuming the core measures are followed appropriately and patients are well taken care of, theoretically reimbursement for patients either with the same or a related condition should be greatly decreased.  This directly results to greater reimbursement for the medical center.  The Centers for Medicare and Medicaid Services – also referred to as CMS – state that, “value-based programs reward health care providers with incentive payments for the quality of care they give to people with Medicare” (“Value-based programs”, 2020). One of the value-based programs refers directly to HAC’s or hospital acquired conditions, which can cause tremendous cost to a medical center and most can be avoided by following the core measures.  For example, according to the Agency for Healthcare Research and Quality, something as simple as a pressure ulcer can cost a medical facility $14,000-$40,000.  Similarly something that happens fairly often, a CAUTI or a catheter-associated urinary tract infection can cost the medical facility $14,000. (“Estimating the additional”, 2017).

Clearly, we can see from those few statistics that a medical facility that does not demonstrate successful achievement of core measures will be impacted both financially but also will have a poor reputation in the medical community which will lead to less referrals and patients also not wanting to go receive care there.  For example, in a suburb of Boston there is a medical center which has a world renowned name attached to it, but people know that they do not provide excellent care and in return they do not have a high volume of patients.  Therefore, the future of organizations and providers who do not focus on core measures will be greatly penalized both financially and statistically which will generate a snowball effect.  If you hear that there are consistent CAUTIs at a certain medical center, or certain repeatable and preventable issues with a specific provider or specific medical center that will smear your image also.  Something such as core measures are something that are so simple to follow since there are national standards of care that everyone is supposed to follow, all it takes is following the rules and effort, however, not following those core measures and standards of care will put the future of that organization or provider in jeopardy

References

Estimating the Additional Hospital Inpatient Cost and Mortality Associated With Selected Hospital-Acquired Conditions. Content last reviewed November 2017. Agency for Healthcare Research and Quality, Rockville, MD. https://www.ahrq.gov/hai/pfp/haccost2017-results.html  

John Hopkins Medicine (2020). Patient safety and quality: Core measures. https://www.hopkinsmedicine.org/patient_safety/core_measures.html

Value-Based Programs. (2020, January).  Retrieved from, https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/Value-Based-Programs

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