|By Sanford, Kathleen D|
Certain dates in history mark significant discoveries that changed how we treat disease. In 1895, the X-ray was invented. In 1928, penicillin was discov- ered, giving physicians a new tool to fight infectious disease. Then in 1955,
Similarly, there are key dates that represent game-changing events for the busi- ness of health care as well. In 1929, the first hospital-based health insurance pro- gram was established. On
It might be easy to overlook this second set of dates, but the truth is that the history of healthcare financing has been intertwined with the history of healthcare deliv- ery for some time. In fact, that link between financing and delivery is still evident today. Just look at the escalating costs of our current healthcare system. For years, we have been an industry that is (mostly) paid to provide tests and procedures, even in cases where there may be little evidence that costly treatments are more effective than more modest interventions.
Part of the problem has to do with incentives. Because most hospital-based sys- tems are paid to care for sick people- and not paid when people are not sick- there has been no financial incentive (for most of us) to focus on keeping people healthy so they will be less likely to require more costly interventions. The tradi- tional, fee-for-service payment system has created an uncomfortable reality that pits our messages of prevention against our financial incentives. We see it every winter On the one hand, we encourage members of our communities to get flu shots, yet we are financially rewarded when they don't. I've heard more than one CFO explain that the reason a system was unable to reach its revenue targets was due in part to "a light influenza season."
But let me be clear: This is not an indictment of hospitals. We are designed- and rewarded- to care for people when they do get sick, and we have done that pretty well. However, we have not had the systems or incentives in place to help patients stay healthy.
That's about to change, thanks to major changes implemented on
The first program, the Hospital Value-Based Purchasing (VBP) Program, focuses on improving quality inside the hospital.3 Through this initiative,
> The percentage of myocardial infarction patients who receive fibrinolytic therapy within 30 minutes of hospital arrival
> The percentage of patients with pneumonia who have blood cultures drawn in the emergency department prior to receiving the initial antibiotic
> The number of postoperative urinary catheters removed on postoperative day one or two
The second program, the Hospital Readmissions Reduction Program, is more revolutionary: It makes hospitals accountable for what happens outside its walls.b Specifically, CMS has begun withholding up to 1 percent of payments from hospitals that readmit certain patients within 30 days of discharge. CMS's methodology for calculating a hospital's excess readmission ratio currently focuses on patients treated for heart failure, heart attack, or pneumonia. With this readmission penalty, CMS makes hospitals at least partially responsible for maintaining the health of their recently discharged inpatients, at least for a short time following hospitalization.