Making Progress on Measuring what Matters
As policymakers, providers and consumer advocates continue to struggle with establishing measures of quality care that make sense, there is some evidence that patient-reported outcome measures are at last gaining some steam. A Health Affairs study examines the use of patient-reported outcomes and finds emerging practices in which this kind of data is collected and used. In one prominent example, the new Centers for Medicare and Medicaid Services bundled payment program for hip and knee replacement will pay providers to collect patient-reported outcomes.
A report commissioned by the U.S Department of Health and Human Services to examine how to fairly pay hospitals that serve disproportionately high numbers of low-income and socially disadvantaged patients found that doctors and hospitals can provide high-quality care at a good value by teaming with community-based organizations. Such arrangements can include partnering with local public health departments, social service agencies and other community-based organizations. The study also found that a commitment to health equity and engaging patients in their care were important to improving care for vulnerable populations.
The Centers for Medicare and Medicaid Services (CMS) continues to move forward with a variety of health system transformation initiatives. In early April, CMS announced the Final Call Letter on the 2017 Medicare Advantage rates,. Of particular interest was the inclusion of changes to the risk adjustment model for 2017, as well as good language on the prohibition of balanced billing. The Medicare/Medicaid Coordination Office also released a memo highlighting the aspects of the Final Call Letter that are applicable to plans serving dual eligibles in the demonstration projects. In addition, on April 11 CMS announced a new program to tie primary care physician payments to overall patient health and outcomes. Over the course of the five-year program, CMS will recruit approximately 20,000 primary care physicians into two different payment tracks that move away from the traditional fee-for-service system. Additional information is becoming available on this initiative on an ongoing basis.
Poll Finds Strong Physician Support for Advance Care Planning, Significant Training and System Barriers
A new survey finds that while virtually all doctors who see Medicare patients consider end-of-life and advance care planning conversations important, many physicians report significant barriers to having these discussions with their patients, and nearly half (46 percent) report that they frequently or sometimes feel unsure of what to say.
The survey – “Conversation Stopper: What’s Preventing Physicians from Talking with Patients about End-of-Life and Advance Care Planning?” – was commissioned by The John A. Hartford Foundation, the California Health Care Foundation and Cambia Health Foundation and includes 736 primary care and specialist physicians in 50 states. Specialist physicians surveyed are oncologists, pulmonologists and cardiologists.
Advance care planning helps people learn about their health care treatment options, figure out the type of care they want and share those wishes with family, friends and providers – ideally in writing and as part of a patient’s electronic health record. People should feel empowered by these conversations and by knowing their wishes will be heard and respected.