IOM Report Calls on Government To Create Unified Health Quality Standards, Reward Providers

Government health programs should establish unified health quality standards and should reward high-quality health care by paying the best doctors, hospitals, nursing homes and HMOs higher fees and bonuses, according to a new Institute of Medicine report, the New York Times reports. The report, requested by Congress, finds that Medicare, Medicaid, CHIP, the Defense Department's Tricare program, the veterans health program and the Indian Health Service -- which together serve about 100 million Americans -- should create equivalent quality standards, assess the performance of individual health care providers and release such findings to the public. "The federal government should take full advantage of its influential position to set the quality standard for the entire health care sector," Dr. Gilbert Omenn, chair of the panel that issued the report and a University of Michigan professor of medicine and public health, said. The report's specific recommendations include the following:

• The government should issue standards within the next two years on how to evaluate the treatment of 15 common health conditions, including diabetes, depression, osteoporosis, asthma, heart disease and stroke.
  
• By 2007, health providers participating in the government programs should submit to government officials quality data on the treatment of the 15 conditions.
  
• Each of the six programs should publicly report the quality findings by 2008.
  
• Health care providers who receive "exemplary levels of performance" as measured by the standards should receive government payments that are 5% to 15% higher than standard reimbursements.
  
• Government health care providers should computerize their medical records in order to facilitate quality evaluation (Pear, New York Times, 10/31).
  
• Congress should pass legislation that encourages the creation of a "national health information system" funded through tax credits, subsidized loans or grants (Associated Press, 10/30).

HHS Secretary Tommy Thompson "welcomed the report" but did not say if the department supports rewarding government health care providers with higher fees and bonuses, the Times reports (New York Times, 10/31). "The report provides input on a number of emerging issues that can be of assistance to HHS and other federal agencies in implementing current and future activities to improve patients' quality of care," Thompson said (HHS release, 10/30). Richard Davidson, president of the American Hospital Association, said the government should work with advocacy groups to develop the criteria, which he said should include "valid and useful measures on which there is already broad voluntary consensus." However, Elisabeth Belmont, corporate counsel for Maine Health, which operates seven hospitals, a nursing home and a home health agency in Maine, said criteria could place providers at greater risk of medical malpractice liability as trial lawyers might argue negligence on the part of doctors who do not meet minimum compliance standards. In addition, Dr. Yank Coble, president of the American Medical Association, said some physicians do not see enough patients to make quality data valid (New York Times, 10/31). The report, titled "Leadership by Example: Coordinating Government Roles in Improving Health Care Quality," is available online.