Provider services and solutions

Clinical operations & quality: Quality & pay for performance

The challenge

Every hospital invests tremendous resources to measure, assure and enhance quality care. The payoffs validate the effort—better patient outcomes, fewer complications, higher reimbursements and competitive advantage. For the past few decades, payers, led by the Centers for Medicare and Medicaid Services, have sought to improve clinical practices by increasing reimbursements to providers who deliver quality care. Working out the thorny details of these pay for performance (P4P) programs has been difficult and controversial, but the principle of paying more to providers who comply with best clinical practices has been firmly established.

CMS is now taking the next step, evolving from a "passive player" to an "active purchaser" of healthcare services. CMS’s new value-based pricing (VBP) model will link reimbursements to how well patients fare under a provider’s care. VBP will incorporate measures of quality, safety, efficiency and patient satisfaction into reimbursement calculations. VBP may significantly improve patient care, but complying with its many requirements will challenge your organization.

How we can help you

• New P4P programs incorporating value-based pricing will increase demands on your data collection and reporting practices. We can help you standardize and integrate your data collection practices and put in place the information infrastructure to support them.
• To comply with P4P quality metrics, you need to frequently evaluate your quality and safety culture and practices. We can help you assess your current quality infrastructure to identify and prioritize improvement opportunities.

Common services include

• Recommending leading quality and safety practices
• Evaluating and prioritizing safety quality and safety opportunities, focusing on clinical delivery and reporting
• Defining the future state of your organization’s quality model
• Analyzing quality-focused data on adverse events and "never events"