GOALS FOR IMPROVED HEALTHCARE PAYMENT SYSTEMS
In order to address the current problems with healthcare payment systems and to avoid the concerns about existing Pay-for-Performance systems, the following are twelve goals that revised payment systems should seek to achieve:
- Payment systems should enable and encourage providers to deliver accepted procedures of care to patients in a high-quality, efficient, and patient centered manner.
- Payment systems should support and encourage investments, innovations, and other actions by providers that lead to improvements in efficiency, quality, and patient outcomes and/or reduced costs.
- Payment systems should not encourage or reward over-treatment, use of unnecessarily expensive services, unnecessary hospitalization or re-hospitalization, provision of services with poor patient outcomes, inefficient service delivery, or choices about preference-sensitive services that are not compatible with patient desires.
- Payment systems should not reward providers for under-treatment of patients or for the exclusion of patients with serious conditions or multiple risk factors. Payment systems should not reward provider errors or adverse events.
- Payment systems should make providers responsible for quality and costs within their control, but not for quality or costs outside of their control.
- Payment systems should support and encourage coordination of care among multiple providers, and should discourage providers from shifting costs to other providers without explicit agreements to do so.
- Payment systems should encourage involvement of patients in decision making, and encourage patient choices that improve adherence to recommended care processes, improve outcomes, and reduce the costs of care.
- Payment systems should not reward short-term cost reductions at the expense of long-term cost reductions, and should not increase indirect costs in order to reduce direct costs.
- Payment systems should not encourage providers to reduce costs for one payer by increasing costs for other payers, unless the changes bring payments more in line with costs for both payers.
- Payment systems should minimize the administrative costs for providers in complying with payment system requirements. Different payers should align their standards and methods of payment in order to avoid unnecessary differences in incentives for providers.
In addition, an overarching goal is to have improved payment systems maintain or reduce healthcare costs, rather than increase them.