Payment Innovations To Improve Diagnostic Accuracy And Reduce Diagnostic Error

Area of Science:

• Health economics
• Medical informatics
• Patient safety

Background:

• Diagnostic accuracy is crucial for effective treatment but is often overlooked in healthcare payment systems, including Medicare and Alternative Payment Models (APMs).
• Current payment structures do not adequately incentivize or support the complex cognitive work involved in accurate diagnosis, particularly in challenging cases.

Purpose of the Study:

• To propose actionable, payment-related strategies for reducing diagnostic errors within existing and future healthcare reimbursement frameworks.
• To highlight the need for integrating diagnostic performance into quality-based payment models.

Main Methods:

• Discussion of three payment-related approaches: 1) Medicare Physician Fee Schedule coding changes to support diagnostic teamwork and IT, 2) development of new APMs focused on diagnostic accuracy with centers of expertise, and 3) confirmation of diagnoses linked to APM payments.
• Analysis of how these approaches can enhance accountability for diagnostic performance.

Main Results:

• Coding changes can better support physicians' diagnostic efforts, especially in complex situations.
• New APMs can provide resources and focus on improving diagnostic accuracy for difficult cases, incorporating quality improvement.
• Verifying diagnoses tied to APM payments is essential for accountability.

Conclusions:

• Implementing these payment-focused strategies can make healthcare reimbursement more accountable for diagnostic error reduction.
• Diagnostic performance should be recognized as a key metric in quality-based payment systems.