Quality Measures for Bundled Payment

Health Affairs has a great post on quality measures for alternative payment structures, including some very valuable measurements that highlight how episodic payment systems can measure quality in a highly meaningful way. Working with Catalyst for Payment Reform (CPR), the Health Care Incentives Improvement Institute (HCI3) analyzed commercial claims data and identified 12 conditions with high variation in safety, quality and cost. Notably, most of these conditions (arrhythmia, asthma, breast cancer, coronary artery disease, depression, diabetes, gastrointestinal endoscopy, hypertension, low back pain, osteoarthritis, pregnancy, and upper respiratory infection) are all priority target areas for bundled payment programs. CPR then identified 30 quality measures that they feel should be priority areas for employers. This is a great start for improving the measurement of quality which is critical to the success of alternative payment including bundled payment. Importantly, some of the measures selected by CPR are focused on both the provider and procedure. Quality measures that combine the procedure and physician remove confounders that exist when attempting to evaluate the physician or organization as an entity. An example of this is the measurement for low back pain "Average Change in Functional Status following Lumbar Spine Fusion Surgery". This quality measure evaluates the physician (or organization) on a specific episode of care creating a very targeted and effective measurement that is not confounded by other procedures that could make a physician with outstanding results look less qualified when merged across multiple orthopedic procedures. This shift in thinking from measuring the physician or organization to measuring the procedure is a key aspect of the benefits of using episodic payment systems.

Unfortunately, there are only three of these measures on the list of 30. Quality measurement has only begun to identify the benefits of evaluating quality at the procedural level, but this is an important step on the path to effective bundled payment systems.