There have been headlines recently announcing the partnerships BCBSMA has struck with MA-based providers called Alternative Quality Contracts that seek to flip the traditional fee-for-service model on its head. Instead, these contracts advocate payments for the highest quality of care, not necessarily the most expensive. BCBSMA boasts, “The AQC now includes 23% of physicians in their network, providing care to 31% of their MA-based HMO members”. There are some recognizable names on the list of organizations already signed up including Mount Auburn, Tufts, Atrius and Caritas Christi among others totaling 9 hospitals and physician groups. I would argue, though, that signing the contract is the easiest part to this partnership (even though the lawyers for both sides may disagree). The foundation of the contracts is the quality measures that both parties agree represent the best way to monitor the quality of the care being delivered. The hard part is finding the most efficient ways to calculate and report the measures to save money and improve revenue from this new model for reimbursement. BCBSMA explicitly states, “Providers can retain margins derived from reduction of inefficiencies.” Well where are the biggest opportunities for “reducing inefficiencies”? The biggest inefficiencies lie in the collection, aggregation, and reporting of the data required to calculate these quality measures!
Almost every hospital I’ve worked, volunteered, or consulted for has the same problem – it takes too long to calculate and report quality metrics. Paper-chasing and manual chart abstraction burden overqualified nurses and delay decision makers from improving their processes. By the time the information is collected, it’s too late to make an actionable decision to either improve or standardize the best practice. Hospitals will clamor, “Our core measures are above 90%”. My response is always, “ok but you just reported June’s numbers and it’s August! And how much did it cost you to report those numbers that you now can’t do much with because you’re two months behind the information?”
In Massachusetts, the public reporting of physician and hospital performance is currently being developed. This trend will undoubtedly spread to the rest of the country, eventually. The demand for transparency of true healthcare costs and quality of care, I’d argue, has never been higher. The AQCs are a great first step in the right direction. But until hospitals and physician groups tackle the bigger problem, the huge amount of time, money and effort currently being wasted on paper-chasing and manual chart abstraction required to collect, calculate, and report their quality metrics, these contracts will only be yet another piece of paper to keep track of. Good intentions don’t equate to good business.