by Tim Gieseke MD, CMD

As you may be aware, Value Based Payments (VBPs) are an integral part of health care reform.  The current volume based fee for service payment system will have VBPs modifiers for each provider in the future tied to outcomes on specific measures developed by specialty societies and organizations such as the National Quality Forum.  These measures require computer EHRs that report meaningful use assessments which have become the norm this year in the acute hospital and office settings.

However, in the 4 Post-Acute Care Settings (Acute Rehabilitation, Post-Acute Care, Custodial SNF Care, and Home Health Care), there has not been a requirement for the current assessment tools (FIM, OASIS, and MDS) to report common data for the development of a standardized resource use data base that would determine patient acuity across these settings.  In addition, quality measures are lacking that link patient acuity to individual physician and NP/PA services across these settings.  

Recently, the Senate and House Ways and Means committees jointly introduced bipartisan legislation to standardize the assessments of patients across the 4 post-acute care settings.  The legislation will require providers to report common data across post-acute care settings for assessing patients and for comparing quality and resource use.  By 2016, quality data would be used to help discharge hospital patient to appropriate facilities.  Providers would report standardized quality and resource-use data in 2017, and in 2019 standardized patient assessment data would be reported.

If and when these ambitious endeavors become reality, a fairer system for connecting all providers to a unified 30 day all cause admission rate, may be achieved.  This data base may also permit development of a VBPs system based on meaningful outcome measures that are appropriate for the high acuity and poor prognosis of many patients who live in our SNFs and Assisted Care Homes.

From my Medical Director perspective, the current payment system doesn’t hold physician and NP/PA providers accountable enough for the outcomes of the services they provide nor does it encourage care coordination or interdisciplinary approaches to complex issues.  As a boomer approaching my Medicare years, I look forward to modifications in payment that encourage better medical care.