Michael Richards, Executive Director of External Affairs at Gundersen Lutheran Health System and Brian Vamstad, Legislative Policy Analyst and Coordinator of the Healthcare Quality Coalition discuss the HQC's work.
Organization Overview
The Healthcare Quality Coalition (HQC) began in 2009 as an ad-hoc group of healthcare organizations advocating for reform to the healthcare delivery and payment system that would incentivize value (high-quality, low-cost care). Through the advocacy efforts of member organizations and close working relationships with Members of Congress and their staff, the HQC has begun to build a foundation for value in the healthcare delivery system. The more than 20 organizations that comprise the HQC include physician groups, hospitals, health systems, associations and medical societies in over 15 states.
Summary
The existing fee-for-service Medicare reimbursement system is flawed. Rather than incentivizing high-quality, low-cost care, the system compensates physicians for the volume of services provided. The HQC advocates for policies that will transform this delivery system to one that incentivizes high-value care.
Moving Medicare to a system to reward value continues to be a daunting task, but the HQC is committed to leading policy reform efforts. The HQC is focused on value-based initiatives for both hospitals and physicians. Our process has been two-fold. The first component has been to identify areas where new policies can be developed to drive value in the system. Our advocacy related to the Medicare physician value modifier provides one such example. Since the inception of the policy, the HQC's close work with lawmakers and their staff to develop a modifier which begins to move Medicare payment for physicians away from volume and towards value showcases the commitment of the group to its guiding principles. This effort was successful; the value modifier is now law and is being implemented at the agency level.
The second component of our work is to ensure that existing value-based purchasing initiatives are appropriately structured to encourage high value care. Programs like the hospital value-based purchasing program and the Medicare physician value modifier provide potential opportunities to guide the transformation of the delivery system. However, these programs must have the right inputs - the right quality measures and cost measures to improve care delivery. This work is ongoing.
Key Challenges
To date, efforts to improve quality and lower cost in Medicare have been too moderate in scope. Research shows the current fee-for-service reimbursement system is linked to increased costs and unnecessary services, but solutions to the problem are being met with barriers. For example, in both hospital and physician value-based payment initiatives, the amount of reimbursement at risk is quite small-generally around 1%. In contrast, we believe that a much larger share of payment must be tied to value if these policies in order for them to be effective. We would recommend an incentive of 10% or more to truly drive the type of change we hope to see.
As with any proposed change, challenges are abundant. Some in opposition cite protection of the status quo, while others are concerned with its impact on their practice/hospital and how much of a reward for improving quality and lowering cost will need to be achieved. Still others want better developed measures of quality and cost before implementation. However, the HQC supports moving value-based payment policies forward, recognizing that waiting longer only exacerbates a program facing significant funding issues.
Next Steps
The HQC seeks to build advocacy partnerships with organizations committed to aligned policy goals. We have identified numerous potential partners through the CMS policy development process, and continue to work with Congressional champions who proved instrumental in advocating for payment reform policies. Finally, the HQC seeks to educate policymakers and build strong bipartisan support around our efforts to reward value.
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