The Quality and Cost Council met Wednesday with the new Executive Director, Katharine London, officially on board. Katharine announced that an initial website, with basic Council information, meeting locations and times, etc., will be up and running soon through mass.gov. We will notify you when the site is up.
Most of the meeting was a presentation about the new MassHealth Pay for Performance Initiative. Here are some excerpts on that conversation from State House News Service:
MassHealth officials on Wednesday unveiled their “pay for performance” initiative that is slated to start in October, when hospitals contracting with the program will be eligible for bonus rate increases by meeting new quality standards. The initiative is earmarked to cost $20 million during its first year … The new program seeks to “reward providers for excelling in or improving quality of care” delivered to MassHealth members, Acting Medicaid Director Tom Dehner said during a Health Care Quality and Cost Council meeting today. …
The new initiative is part of the health care reform law enacted a year ago, which calls for MassHealth hospital rate increases to be contingent on quality standards and performance measures, including the reduction of racial and ethnic disparities. “We are in this for the long-term. We’re excited about this work,” said Dehner.
Under MassHealth’s proposal, Dehner said all acute care hospitals contracting with MassHealth will be asked to provide information relative to five measures: maternity, pediatric/asthma, pneumonia, health disparities and surgical infection/prevention. Hospitals will also be required to participate in at least one public reporting initiative, which discloses basic safety practices. After the data is assessed, MassHealth would then reward “bonus points” to hospitals based on their ability to meet industry benchmarks, minimum thresholds and improvement markers.
Because MassHealth has not collected data on some of the measures, Dehner said during the initiative’s first year, hospitals will be compensated for improvement in some comparative areas and for reporting only in new areas.Some council members expressed disapproval about rewarding hospitals for reporting only.
Referring to language under the new health care reform law, Gregory Sullivan, a council member and the state’s inspector general, said he wanted “strong mandates” to set clear improvement standards for hospitals. “This is a very important initiative,” said Sullivan.
Dehner said he wanted to give hospitals a chance to understand all the new requirements in the first year. He also said MassHealth needed to collect data first on new measures before holding hospitals accountable for performance. “I think this is an area where it’s important that we design a way that is understandable so the measures are clearly determined and understood and margins can be tracked,” said Dehner. “I don’t think the way for us to approach this . . . is for us to say ‘here are the standards, if you don’t meet them you don’t get it.’ ”
Council member Dolores Mitchell spoke in favor of a more stringent approach. “I think we have to be willing to accept a certain degree of risk,” said Mitchell, who said Dehner should take advantage of the attention the new health law has received so far and hold hospitals accountable for quality standards. “I think you have to go to a high level of expectation. To miss the opportunity is a mistake.”
“This is not a one-year deal,” said Dehner. “I think this is a small minor first step in terms of where we need to be.” Other council members expressed support for Dehner’s incremental approach. “We are doing the right thing now based on where we are,” said council member David Friedman. When council members asked Dehner if the initiative would receive more than $20 million after the first year, he said it would, but did not provide a figure. For the next fiscal year, MassHealth estimates it will spend $1.18 billion in acute hospital care costs.
Under the new health reform law, MassHealth must consult with the council and the MassHealth Payment Advisory Board in developing quality standards and performance benchmarks.
The Council discussed an outline of overall goals for FY08. An updated version will be available soon. We will post them when we receive them. The goals included some HCFA priorities, such as infection reporting and elimination of infections, never events reporting, reduction of health disparities, chronic disease management, and promotion of preventive care.
The Council discussed draft regs for collecting claims data from third party payers. The data would be used to develop info about quality and cost to be posted on a website. The Council will vote on these regs at a future meeting, and after public comment and hearings. Many advisory committee members submitted comments with concerns about privacy. Read the overview and the actual draft regulations here. Tell us your comments.
Upcoming meetings:
June 6: Council and advisory committee meet. Dr. Elliot Fisher will speak about regional variations in care. He is an expert on this topic. 1-3pm at 1 Ashburton Place, 21st floor.
June 20: Council Meeting, 1-3pm, 1 Ashburton Place, 21st floor.
September 19: The Council’s first annual meeting. This may be a longer session (full or half day) with a number of speakers.
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Implementing Pay for Performance through MassHealth payments is an odd strategy. For most hospitals, MassHealth is such a small revenue source that any incentives will be meaningless. MassHealth should focus its efforts on the three or four hospitals that receive the most MassHealth revenue, and leave it at that.