Most of the energy in Washington has surrounded the insurance component of reform. Although it is a laudable goal to have all Americans covered with some form of health insurance it is only one step. without significant delivery reforms Medicare and Medicaid simply go bankrupt sooner.
The first step in delivery reform should be transparency of heath care performance. The reason is that providers who report performance that is poor or even average compared to peers have been shown to significantly improve that performance. Most of our experience in reporting quality measures like A1-c rates and LDL cholesterol levels is at the Wisconsin Collaborative for Healthcare Quality www.wchq.org .We have seen dramatic improvements in performance by many of the providers that have been publicly reporting since 2003.
In the present bills in the house and senate there is verbiage related to performance reporting. The way this is written it would be a CMS initiative rather than one at the state or regional level. Our experience in being a CMS BQI (better quality information) pilot site is that it much more likely that regional or state quality collaboratives have a better chance of achieving the reporting requirements than a federal program. Each state has different issues with physician reporting and physicians are less willing to work with the federal government than state public private partnerships when it comes to design and compliance of reporting initiatives.
It is our contention that if reporting is done appropriately we can dramatically reduce cost and improve quality. for example,if a reporting initiative required hospitals and physicians to report medication errors on inpatients and outpatients we would likely see huge reductions in errors. The caveat is what are the definitions. Are we going to report medication reconciliation errors, near misses, or actual errors that do harm. The definitions will take years to work out at the federal level but at WCHQ or The Wisconsin Hospital Association we could probably come to agreement relatively shortly as to what we can measure right now.Doing things this way would also create some competition between states on which state was coming up with the best ideas.This would spread much more quickly than a federal mandate to report.
Let's leverage what many states already have rather than recreating an ineffective wheel of new federal government mandates for reporting.
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