The Insanity of Quality

HHS is mandating payment for quality for Medicare reimbursement. Specifically they state:

In a meeting with nearly two dozen leaders representing consumers, insurers, providers, and business leaders, Health and Human Services Secretary Sylvia M. Burwell today announced measurable goals and a timeline to move the Medicare program, and the health care system at large, toward paying providers based on the quality, rather than the quantity of care they give patients.

I would remind folks that in Zen and the Art of Motorcycle Maintenance that it was the attempt to define quality that drove the prime character insane. Quality is complex and near impossible to define no less measure.

They continue: 

HHS has set a goal of tying 30 percent of traditional, or fee-for-service, Medicare payments to quality or value through alternative payment models, such as Accountable Care Organizations (ACOs) or bundled payment arrangements by the end of 2016, and tying 50 percent of payments to these models by the end of 2018.  HHS also set a goal of tying 85 percent of all traditional Medicare payments to quality or value by 2016 and 90 percent by 2018 through programs such as the Hospital Value Based Purchasing and the Hospital Readmissions Reduction Programs.  This is the first time in the history of the Medicare program that HHS has set explicit goals for alternative payment models and value-based payments.

 Note that the goal is 85% to quality. We have written extensively on this topic and its complexity. The ability to deliver anything like a quality measure is not only problematic but we believe impossible. It is merely a Government plan to cut costs and ration service.