Sunday, April 08, 2012

Does HQID work? 

            It has for some time been suggested that the providers of health care could be induced to improve the quality of the care they provide by paying them bonuses if they did so. 

            I have been skeptical about that.  As I see it, the barriers to quality improvement are deeply rooted in the culture of health care.  Given the difficulty of changing any culture, and given that providers are pretty well paid already, it has seemed to me that making the bonus approach work would take a very long time and a whole lot of money. 

            Now it appears that my skepticism might be justified.   

An article in the April 2 issue of Modern Healthcare reported a recent study by researchers from the Harvard School of Public Health.  The study concluded that a bonus-for-quality project known as HQID has so far led to no long-term reductions in 30-day mortality rates when compared with hospitals not participating in HQID.   

HQID is the acronym for the CMS/Premier Hospital Quality Incentive Demonstration, a program initiated under the Bush administration.  CMS is the acronym for the Center for Medicare and Medicaid Services, a federal agency.  Premier is a hospital purchasing collective that also engages in other joint hospital endeavors. 

Some 250 hospitals are participating in the program.  They report quality data to Premier, which submits it to CMS.  The data is scored according to established criteria and the best scoring hospitals are being paid a bonus. 

Premier objected vigorously to the Harvard study, raising a number of challenges to its validity.  But the Harvard School of Public Health is a well-regarded institution and I doubt its researchers would be publishing anything that the School wasn’t comfortable standing behind. 

I’m sure there are ways to use economic incentives effectively in health care, but I continue to doubt that bonuses for quality are among them.

Friday, April 06, 2012

Mandatory Broccoli Insurance 

I’m no big fan of Obamacare, but I thought the Solicitor General’s recent defense of it before the Supreme Court was weak. 

According to the papers, one of the Justices made reference to the broccoli bit.  Some of the opponents of the Affordable Care Act have asked whether if the federal government can require people to buy health insurance, it could also require them to eat broccoli.  The Solicitor General apparently gave that one a pass. 

Here is an answer that occurred to me: 

The only way broccoli would become relevant to the matter under discussion is this:  If broccoli was found to have curative properties, if the condition broccoli treated was episodic and unpredictable, if broccoli came to cost ten thousand dollars a head, and if society believed that everyone who needed broccoli should have it, then there might well be a need for mandatory broccoli insurance.                     

The argument sounds good to me.  I don’t know how to fit it into the constitution, but clever lawyers ought to be able to find a way.

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