Since the publication of Crossing the Quality Chasm, the quest for significantly improved health care quality for all Americans has been joined by a wide variety of stakeholders. Beginning with the Institute of Medicine, virtually all recent commentators on quality acknowledge that for real change to occur, we need a different payment model.
Fee-for-service pay stimulates overuse-the more you do, the more you get paid. Capitation and diagnosis-related group payments reward underuse-the less you do, the more money you make. Pay-for-performance has emerged as an increasingly deployed technique to compel better quality results more quickly than the pace of historical evolution would produce, but it offers small amounts of money on top of fundamental systems that drive toward different results. How can these challenges be met in a new payment model? Some would prefer to focus on paying for outcomes alone. Not only is there considerable debate over whether there is any way to determine who is responsible for an outcome to which payment might be linked, but what would the price of an outcome be?
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| AJMQ_NewModelWhyCare.pdf | 38.81 KB |
