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.

This entry was posted on October 16, 2017 at 11:21 pm and is filed under Blog. You can follow any responses to this entry through the RSS 2.0 feed.