Outcomes and Incomes

A quote today by safety expert John Nance spoke directly to my interests at the intersection of safety, quality, and policy. The new paradigm in healthcare, he said, is “no outcome, no income”.

The path from fee-for-service to value-based reimbursement has been long and often tortuous, and we’ve not yet made a full transition to rewarding health rather than illness.

It is important to be mindful, however, that well-intentioned changes can sometimes have unexpected consequences. A recent paper in Health Affairs showed that a Medicare payment policy change intended to incentivize an appropriate length of stay for patients in long term care hospitals, has likely resulted in gaming of the system. The result: many patients are discharged on the very first day that meets the threshold for full payment.

While this paper didn’t explore the outcomes consequences of this pattern, what’s clear is that a policy designed to align payment to clinical practice didn’t work, and that an event as important to long-term patient well being as a discharge should be driven exclusively by best clinical practice, not reimbursement.

When health care decisions are driven by rules and regulations designed without quality and safety as the most fundamental goal, patients suffer.