By Mary Agnes Carey, CQ HealthBeat Associate Editor
September 9, 2008 -- Paying health care providers more to do quality work and insisting they abide by a set of minimum quality standards would go a long way toward improving the quality of medical care that patients receive, witnesses told the Senate Finance Committee Tuesday.
After his testimony, William Roper, chairman of the board of directors of the National Quality Forum, said he would tie as much as 5 to 10 percent of a provider's payment to the quality of care they delivered. Roper told the Finance panel that changing the health care industry's attitude about quality will take time but be well worth it.
Roper ought to know. The former director of the Centers for Disease Control and Prevention and former administrator of the Health Care Financing Administration (now the Centers for Medicare and Medicaid Services, or CMS), Roper has worked on the issue for 25 years and has seen institutions' focus on quality rise from being "the committee that met on Tuesday afternoons" to being a major concern among health care providers. "Now quality is everybody's problem," said Roper, who also is CEO of the University of North Carolina Health Care System and dean of the university's medical school.
Tuesday's session was one of several hearings the Finance panel has held to discuss the complicated issues involved in overhauling the nation's health care system. Previous sessions have focused on controlling health care costs and expanding access to care. Quality is critical part of the equation, said Finance Chairman Max Baucus, D-Mont.
With health care costs growing at roughly seven percent a year, "we simply cannot afford to continue paying for inappropriate or inadequate medical care," Baucus said. "We need to encourage high-quality and high-value care. And we need to reward health care providers who deliver it."
Sen. Charles E. Grassley of Iowa, the panel's ranking Republican, agreed. "We need incentives for quality versus quantity," he said.
Panelists offered several approaches to improving health care quality. Peter V. Lee, executive director of national health policy for the Pacific Business Group on Health, urged the creation of a major national initiative to measure and compare the effectiveness of drugs, devices, and procedures with a process "that can be trusted by all stakeholders by being transparent and rigorous." Baucus and Senate Budget Committee Chairman Kent Conrad, D-N.D., have introduced legislation (S 3408) to create a public–private institute to perform comparative effectiveness research.
Lee also urged the development of "robust, independent systems" for collecting and reporting performance results on patients' outcomes, cost and patients' views of care and "whether the right processes of care are being delivered by doctors, medical groups, hospitals, nursing homes, and other providers."
The Finance witnesses also stressed that there must be widespread consensus among health care providers about how quality is measured, with the measures tested in pilot projects before they are more broadly implemented. One set of quality standards to follow, rather than different sets from private insurers and federal or state government health care programs, also would make it easier for providers to participate.
Financial incentives are critical as well, witnesses said. Greg Schoen, regional medical director of the Fairview Northland Medical Center in Princeton, Minn., said his facility earned $40,445 over three years for participating in a hospital quality incentive demonstration operated jointly by CMS and Premier Inc., a hospital consortium.
Receiving that money was an incentive for the facility to do well, as was discovering that his hospital's quality performance was in the bottom 10 percent of participating hospitals. His staff worked harder to correct problems. "It created a focus in our organization that had not existed previously," he said, adding that the facility had to bear additional start-up costs as part of the program.
While money is important, so are mandates for participation. Without that pressure, providers may not make the widespread health care quality changes that are necessary system-wide, witnesses told Finance members.
To implement broader use of health information technology, for example, Medicare could require it as part of participating in the program, Roper said. "Without that kind of vigorous push by people in Washington leading the charge, it's not going to happen," he said.
