Researchers want bundled payments to ‘measure what matters to patients’

A group of researchers proposed overhauling the way CMS measures quality in bundled payment programs, citing a need to gauge what truly matters to patients.

Currently, CMS’s bundled payment programs evaluate treatments based on their cost, utilization and short-term complications, the authors wrote in an opinion piece published April 10 in the Annals of Internal Medicine. Missing from this equation, they said, are long-term complications, the appropriateness of the procedure and diagnostic errors, which have been shown to lead to patient harm.

In addition, validated patient-reported outcome measures could contribute to a better understanding of the value of the procedure, wrote Peter J. Pronovost, MD, PhD, and colleagues.

“They are especially important for elective treatments that are performed to improve quality of life,” the authors wrote. “For example, patients having sinus surgery typically want a better quality of life that includes fewer missed days of work. In addition, it is important to evaluate patient-reported outcome measures beyond the standard 90-day post-treatment period.”

Another patient-reported outcome that could inform whether a treatment was effective, the authors said, is out-of-pocket medical expenses related to the condition that was originally treated. This could be combined with Medicare expenses and time off work to more accurately reflect total cost.

“We believe that CMS should do more to measure what matters to patients,” the researchers wrote. “In addition, we think that the investments necessary to develop and implement these ‘measures that matter’ will be worthwhile because they will drive high-value innovations in diagnosis and therapy. We also note that the ideas we are proposing focus on bundled payments but apply broadly to all quality measurement.”

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