The authors point out that in Illinois, a moderately complex office visit is paid at $99 for Medicaid and $160 for BCBS. While that should hint at the underlying problem, the DMCB predicts that the authors' "mystery caller" methodology will be adopted by State Medicaid programs, and that clinics that routinely turn Medicaid patients away will be somehow sanctioned.
Taxpayers Don't Get What Can't Be Measured: The second article is from Health Affairs. The DMCB didn't know this, but a part of Massachusetts' 2006 health reform included the state's Medicaid program ("MassHealth"). A pay-for-performance program was specifically aimed at reducing racial and ethnic health care disparities. The clinical performance measures were based on an aggregate score based on a complex formula that used combination of observed versus optimum rates of surgical infections, pneumonia care, pediatric asthma care and maternal and neonatal health for minorities versus whites. Hospital "structural" measures focused on governance, administration, management, service delivery and customer relations.
Despite widespread support among hospital administrators, the program was limited by low white vs. persons of color baseline differences, as well as small sample sizes that limited statistically valid comparisons. In addition, hospital administrators reported that the program operationally burdensome, because if was layer on top of the other mandated reporting programs required by other state agencies. The authors also point out that the legislature simply didn't anticipate that patients with varying ethnicity would be unevenly distributed across the Commonwealth's hospitals, or that the chosen measures didn't demonstrate that there were disparates.
While the program may have benefited from better planning, the DMCB thinks this was a nice try. It's also an example of the benefit of limiting health reforms to the State level. Imagine the colossal waste of money would have occurred if this had been mandated by Congress at the federal level.