Value-less Based Purchasing

Because I no longer have an official relationship with NorthBay Healthcare, I try to limit my comments about that organization in this space.  Rather than looking back, I prefer to look ahead.  I’m the Healthcare Outsider now.

Nevertheless, I had a reason to go to NorthBay’s website recently to do some personal health related business.  The NorthBay site (www.northbay.org) has been redesigned.  I find the new look very attractive.

I also discovered that a selection of some of the blog articles I wrote when I was CEO (aka the “Healthcare Insider”) are still available on the site. That’s a mixed blessing as I always worry that I might contradict myself from one blog to another.  My past could come back to haunt me.

One of my more or less persistent themes in those blog articles had to do with the inconsistency of various systems used to rate hospitals, particularly those ratings involving patient care.  Almost all these rating systems rely on a data base developed by the agency overseeing the Medicare program.

As I pointed out in several blog entries, it was very possible to be highly rated by one entity for a given condition and lower rated for the same condition by another entity.  It all depended on how the data was sliced and diced, when it was manipulated and sometime what I believed to be inherent bias of some rating organizations.

Most distressing I am sure to some of the rating organizations was the fact that there was little evidence that anyone used the results to make decisions about where to go for treatment.  Given the inconsistencies, the public was showing good sense.

Now it is emerging that one of the seminal rating systems focusing on quality measures is finally being confronted about its methodology.  That would be the so-called Yale New Haven Study which examined among other things readmission rates.  I am not a clinician or an academic but I did write several times in my old blog  about common sense concerns I had about some of the conclusions reached about readmission rates in that study.

Those conclusions were important because hospitals were judged by them and Medicare reimbursement could be affected.  This was the start of the so-called “value-based purchasing program” which Medicare was trying to roll out in an attempt to improve patient care and save money, mostly the latter.

Could it be possible that value-based purchasing (i.e., what Medicare will pay for care) is based on incorrect conclusions. Yes, indeed!

There is also now emerging concerns about whom the Feds are giving grants for further research into measuring quality care and the criteria being used for selection. Some observers say the same folks who did the initial research for Medicare are getting most of the funding and that poses a potential conflict of interest.

So far my past musings on this issue are not haunting me and for that I am glad,  I am concerned, though, that so many important decisions may have been made on a study which was not further substantiated.

The jury is still out about this type of research but if other more neutral researchers continue to find flaws with the conclusions of the Yale study, value-based purchasing maybe should be called “value-less based purchasing”.