Wednesday, March 19, 2008

Hospitals, P4P, Non-Payment of Medical Errors, Performance Guarantees and Disease Management

While the disease management care blog has been aghast at Dancing Priscilla’s botox overdose and egregiously bummed over Robert Plant’s decision to tour with Alison in lieu of Jimmy, at least it has a 2008 Yes Tour to look forward to. In the meantime, it will make do with CBS’ on-line streaming of March Madness, which includes a video player with “boss button.” Click it and a spreadsheet will cover your screen.

The DMCB thinks bosses should be pleased if their employees regularly log onto this web page, so no boss button is necessary. Read on, leave it up and be proud. In fact, forward the link to the big guy: you'll be thanked.

Speaking of CBS, it has another interesting bit of news video that describes a medication error involving the newborn Quaid twins. While the pharma's tone deafness in a separate video makes for creepy viewing, readers may be more interested the implications of what CBS offers up as one solution: hospital package pricing with “performance guarantees” for an the episode of care that extends beyond the initial hospitalization. If the patient needs to be readmitted, that cost is generally covered. For those readers interested in methodology, this has been described in one publication using a pre-post study design in a setting of dubious generalizability.

What’s more, the lack of detail makes the DMCB suspect performance guarantee contracting is actuarially neutral, i.e., priced to account for an expected rate of complications. That may be one reason there hasn’t been a stampede among health insurers to adopt the guarantee approach. Rather, they seem to prefer sticking to their pre-existing fee schedules and turning up the heat with more blunt approaches of carrots (P4P bonuses) and sticks (non-payment for medical errors).

The DMCB asks: who cares? Hospitals will need to improve their in-house care processes but that alone is not sufficient. There is considerable literature showing better patient preparation prior to an elective admission is important and that post-discharge planning often goes awry. Enter the disease management companies which can add value across a wide number of inpatient conditions and their associated episodes of care. For example, they have resources that may be of use prior to surgery in helping patients choose their best treatment options ahead of time, and they have a track record of reducing readmissions once patients are discharged. This may not apply to all conditions treated all ways in all hospitals in all settings, but there is some merit to this approach.

As the pressure grows to increase quality and avoid errors, hospitals may soon turn out to be another customer of disease management companies. In other words, in the opinion of the DMCB, these companies may be able to help secure the bonus, avoid the unnecessary readmission or fulfill the guarantee.

No comments: