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Rethinking Medicare Payment Adjustments for Quality.

Richard F Averill1, Richard L Fuller, Elizabeth C McCullough

  • 1The Hesperium Group, LLC, Seymour, Connecticut (Mr Averill); 3M Health Information Systems, Silver Spring, Maryland (Mr Fuller and Ms McCullough); and Yale University School of Medicine, New Haven, Connecticut (Dr Hughes).

The Journal of Ambulatory Care Management
|March 6, 2016
PubMed
Summary
This summary is machine-generated.

The proposed Outcomes Act shifts healthcare payment reform from complex process measures to a unified, outcomes-based system. This aims to truly incentivize healthcare value and quality, simplifying quality measurement.

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Area of Science:

  • Health Policy
  • Healthcare Management
  • Quality Improvement

Background:

  • Current healthcare payment reforms often focus on process measures.
  • This focus leads to overly complex systems that obscure the goal of paying for value.
  • A fragmented approach to quality measurement hinders effective payment reform.

Purpose of the Study:

  • To introduce the "Incentivizing Health Care Quality Outcomes Act of 2014" (HR 5823).
  • To propose a shift from process-based to outcomes-based quality measurement.
  • To advocate for a uniform and comprehensive system for measuring healthcare quality.

Main Methods:

  • Analysis of existing healthcare payment reform policies.
  • Examination of the limitations of current process and outcomes measures.
  • Proposal of a new legislative framework for quality measurement.

Main Results:

  • The Outcomes Act offers a unified, coordinated, and comprehensive approach.
  • It replaces the current patchwork of quality measures.
  • It facilitates a move towards measuring and incentivizing actual healthcare value.

Conclusions:

  • The Outcomes Act represents a significant policy shift in healthcare payment.
  • Adopting an outcomes-based system simplifies quality measurement and enhances value.
  • This approach better aligns payment with desired health outcomes.