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Doubts About Value-Based Hospital Programs

October 16, 2017
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Two recent studies raise doubts about Medicare programs aimed to improve hospital outcomes.

One study evaluated voluntary participation in Medicare’s Hospital Readmission Reduction Program, which included 3 “value-based” reforms: meaningful EMR use, bundled care initiatives, and pioneer and shared saving accountable care organization programs. It reported lots of outcomes, and its overall conclusion was that participation in value-based reforms was associated with greater reduction in admissions. Thousands of hospitals were measured, which means that small differences were statistically significant. Almost all of the reported changes were less than 1% compared to hospitals that did not participate in any of the 3 reforms.

Another study looked at value-based purchasing, by many of the same authors actually. Conditions examined included heart attacks, heart failure, and pneumonia. In the value-based purchasing hospitals vs. control hospitals that did not participate, there were no differences in clinical processes, patient experience, or mortality in 2 of the 3 conditions (there was a 0.43% reduction in pneumonia deaths).

I realize that change is hard, especially in a complex organization like a hospital. But given the fact that this country wastes about one trillion dollars a year on our poorly prioritized exorbitant healthcare system compared to all other developed countries, these efforts are clearly paltry compared to where we need to go as a country. Our national hospital quality is not our primary outlier compared to the rest of the world, it’s our costs, which neither of these Medicare programs do anything to address.

3 Responses to Doubts About Value-Based Hospital Programs

  1. Spring Texan on October 17, 2017 at 8:09 am

    Did the studies not look at cost differences? If quality is more or less the same, and the “value-based” interventions reduced cost, they would be very worthwhile.

    Your last paragraph intimates they didn’t save costs, but I don’t see where the factual basis for that is addressed. Can you clarify?

    • Richard Young MD on October 18, 2017 at 8:42 pm

      Neither study reported cost outcomes.

      What I said in the last paragraph was, “Our national hospital quality is not our primary outlier compared to the rest of the world, it’s our costs, which neither of these Medicare programs do anything to address,” which is a true statement about the reports of these programs. If they did not report cost reductions, then they are not addressing the cost problem.

      Thanks for your great questions.

      • Spring Texan on October 23, 2017 at 9:10 am

        That’s weird that they didn’t include cost information in the reports. Seems to miss the point!

        Thanks for the clarification!

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