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Paying hospitals for quality care

November 7, 2011

Blue Cross Blue Shield of Rhode Island is embarking on a new way to pay hospitals for their services. The largest health insurer in Rhode Island is tying its reimbursement rates to quality of care.

This is how the system will work- Blue Cross Blue Shield will pay hospitals  base rates for their services, plus inflation every year. If the medical centers want to make more money, they have to meet a series of quality measures.

Here are some of the ways Blue Cross will evaluate quality-

Quality scores on the treatment of specific conditions including-

  • heart attacks
  • heart failure
  • pneumonia
  • prevention of surgical infections

Outcomes of patient surveys.  Questions on things like-

  • pain management
  • cleanliness
  • communication with doctors/nurses

Hospital’s rate of preparing patients to leave the hospital. Must do things like-

  • Offer contact information for a doctor at the hospital
  • Contact patient’s primary care doctor about the patient’s stay
  • Schedule a follow-up appointment

Go here to read Blue Cross Blue Shield’s description of the quality measures.

BCBS says so far, 90% of the hospitals in its network have signed on to participating in this new system. The goal is to get that percentage up to 100%.

Curious about how Rhode Island hospitals compare so far? Blue Cross Blue Shield created a simple chart with data on every medical center in the state alongside the national averages for various quality measures.

The information comes from the Centers for Medicare and Medicaid Services and the Hospital Consumer Assessment of Healthcare Quality Information from the Consumer Perspective. Go here to read the info in detail.

A quick glance at the charts shows Rhode Island hospitals are usually at or around the national average on most standards, with one exception. Patients report that their rooms were always quiet at night only 51% of the time. The national average is better, but not by much, at 57%.

I was surprised to see that patients said “staff always explained medication before administering” only 58% of the time in Rhode Island and 60% of the time nationally.  Only 69% of patients in Rhode Island and across the country would “definitely recommend the hospital.”

But what about the individual hospitals in RI? Who’s the worst? Who’s the best? It really depends on the quality measure. Have pneumonia? Go to Newport Hospital or South County Hospital. They both had the highest quality scores for “pneumonia process of care measures.” Have a heart attack? Go to Rhode Island Hospital. It scored 100% on “heart attack process of care measures.”

So what does this change mean for patients? The idea is hospitals should be rewarded not just for the number of people they treat, or because they have more bargaining power as a member of a large hospital chain, but because they’re offering better services. Hopefully that means local medical centers will put more resources into making your stay better and making your transition back into the community safer.

What do you think? Will it work?

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