AHQA Applauds IOM Recommendations to Reward and Assist Providers to Improve Health Care Quality

Washington, DC — The American Health Quality Association (AHQA) supports recommendations issued in a report today by the Institute of Medicine (IOM) calling for a phased-in national pay for performance program that will provide financial incentives for care that is safe, effective, timely, patient-centered, efficient, and equitable. The IOM recognizes the important role of Quality Improvement Organizations (QIOs) in facilitating pay for performance initiatives in many states and recommends a broader range of responsibilities for the organizations.

The report, “Rewarding Provider Performance: Aligning Incentives in Medicare,” is the third and final part of the IOM’s Pathways to Quality Health Care series. The first report on quality measurement was published last December; the second report, on the Quality Improvement Organization program, was published in March.

“AHQA supports payment to reward high levels of quality and improvements in quality. But IOM is right to say that payment rewards alone won’t get the job done,” said AHQA Executive Vice President David Schulke. “Take surgical infections, for instance. When a patient has a post surgical infection, hospital costs per case double, and their profit margin per case falls by 85% -- a huge financial incentive. If financial rewards were all we needed to stop surgical infections, they would have stopped long ago. Clearly, financial rewards are not enough to produce better quality -- they are just one important piece of the quality puzzle. As IOM has recognized, doctors, nurses, and pharmacists need help to figure out new ways to work together so every patient gets the benefit of these life-saving and money-saving changes. QIOs provide that help.”

QIO Technical Assistance
The report notes that QIOs offer an “important national resource in building the necessary infrastructure” for the technical assistance that providers need to qualify for payment incentives. “Technical assistance for quality improvement will become increasingly important throughout Medicare as pressure to contain health care costs grows, and providers place more emphasis on quality improvement with the expansion of pay for performance programs,” the IOM said.

AHQA agrees that QIO technical assistance should be available to more providers, and supports legislation to advance the agenda. On July 24 Representative Michael Burgess, MD, (R-TX) introduced legislation (HR 5866) that, among other things, will codify the QIOs’ technical assistance and quality improvement functions, which are not currently written into law. On August 31, Secretary Leavitt sent recommendations to Congress to implement IOM’s March report on the QIOs, making a number of suggestions consistent with the Rep. Burgess’ legislation.

Active Learning System
AHQA encourages Congress to direct QIOs to serve as an independent national feedback mechanism for the “active learning system” IOM recommended in its report. The QIOs would report back to federal agencies on consumer, employer, and provider perceptions regarding federal transparency initiatives. QIOs could also alert these agencies to measurement problems and unintended consequences of pay for performance efforts – such as decreased patient access. “Feedback from stakeholders is essential in developing a sustainable program to meets the needs of the public and the providers. QIOs are a uniquely qualified national infrastructure with both the strong local relationships and the expertise needed to help the Secretary continuously improve this program,” said Schulke.

AHQA represents the national network of QIOs, organizations that work for the public and payers such as the Medicare program to improve the quality of health care in America. The Medicare QIO program, administered by the Centers for Medicare and Medicaid Services (CMS), represents the nation’s largest federal investment in health care quality improvement.

Editor’s note: The IOM report “Rewarding Provider Performance: Aligning Incentives in Medicare” is available at: http://www.iom.edu/CMS/3809/19805/36909.aspx.