Link Between Performance Measures and Reimbursement

Quality performance measures are critical and used for various purposes in the healthcare field including regulation, surveillance, and clinical care improvement (Adirim et al., 2017). The existing quality performance measures in the healthcare sector are classified into three categories i.e. outcome, structure, and process. However, quality performance measures seek to address the areas of quality across the continuum of care. Over the past few years, quality performance measures are increasingly linked to reimbursement given the emergence of the concept of pay for performance. In this regard, performance is linked to reimbursement in terms of enhancing patient satisfaction, best practices, and metric-driven outcomes. Payment for healthcare services is rapidly evolving to reward value through evaluating and paying for quality and spending performance (Ryan & Rodgers, 2018).

There are some challenges and benefits of the relationship between quality performance measures and reimbursement. Some of the benefits of this relationship include improving the quality of healthcare delivery, enhancing patient satisfaction and outcomes, and preventing rationing care for the vulnerable and sick (Ryan & Rodgers, 2018). For example, when quality performance measures are linked to process and outcome in terms of reimbursement, the quality of life of severely ill patients is reduced. In this regard, quality measures are linked to reimbursement on the premise that healthcare providers receive payment depending on the quality of services they provide and their impact on patient outcomes and satisfaction. For seriously ill patients, value is rewarded by linking spending with quality. However, there are some challenges in the relationship between quality performance measures and reimbursement including a lack of clarity on how to link spending and quality measures. Secondly, there have been limited efforts to create spending measures for different patient populations.

References

Adirim et al. (2017, January). A New Era in Quality Measurement: The Development and Application of Quality Measures. Pediatrics, 139(1). Retrieved from https://pediatrics.aappublications.org/content/139/1/e20163442

Ryan, A.M. & Rodgers, P.E. (2018, March 1). Linking Quality and Spending to Measure Value for People with Serious Illness. Journal of Palliative Medicine, 21(2), S-74-S-80. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5756459/