As I See It: Quality programs

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Tom Sullivan
Tom Sullivan

A key feature of healthcare reform is paying for quality vs. quantity. Through the American Economic Recovery and Reinvestment Act of 2009 and the Affordable Care Act of 2010, the government created programs to incentivize health systems and healthcare providers for treating for quality vs. the traditional fee-for-service model. Thus far this system has utilized incentive payments, but soon those will give way to penalties.

Starting this year, the healthcare providers will be penalized on their 2015 reimbursement from the federal government unless they meet certain “quality” standards in 2013. The programs have confusing names like Physician Quality Reporting System (PQRS), Meaningful Use and Value Based Payment Modifier (VBPM).  In the future, healthcare providers and hospitals may face close to 10% penalties for not participating in these programs or for poor performance in meeting these quality measures. Keeping up with all these quality programs often feels like a safari in a jungle of government paperwork.

Knowing that the healthcare system needs information on how to improve quality and the concern by healthcare professionals that they face numerous penalties creates an opportunity to help health systems and healthcare providers understand and meet the quality measures required by these programs.

The opportunity for us is to understand these programs and figure out where we can provide value and assistance in meeting these measures. The healthcare system needs a road map to meeting these quality measures, and who better to provide them with the tools they need than those of us who work full-time improving the healthcare system through innovation.


Tom Sullivan is president of Rockpointe, an accredited CME company.

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