WellPoint To Adjust Hospital Payment Policy To Reflect Care Quality
WellPoint is changing its reimbursement system for about 1,500 hospitals in 14 states serving its BlueCross BlueShield plans, eliminating annual payment increases if hospitals do not provide quality care, the Wall Street Journal reports.
In recent years, WellPoint has increased payments to the hospitals by an average of 8% annually. However, the new system will pay increases only to hospitals that deliver on 51 indicators of treatment quality, such as whether:
- A hospital seeks to prevent readmissions;
- A hospital follows a safety check list; and
- Patients report satisfaction.
According to the Journal, the strategy reflects a broader change in the industry to compensate health providers based on care quality. Although other large insurers have taken steps to tie reimbursement to patient outcomes, lobbyists and industry experts say WellPoint is the first major carrier to make a new payment system mandatory for all hospitals serving its affiliated plans.
Samuel Nussbaum, chief medical officer of WellPoint, said almost 500 of WellPoint's hospitals already are taking part in a voluntary version of the program. He said they are receiving average pay increases of 7% to 9% per year.
However, some hospitals are concerned that systems could be penalized because they care for sicker patients, such as facilities in low-income and urban areas. They argue that care quality indicators do not account for these variables.
Chip Kahn, president of the Federation of American Hospitals, said, "We don't have good outcomes measures yet," adding, "Many things will happen 30 days (after discharge) that have nothing to do with hospital care" (Adamy, Wall Street Journal, 5/16).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.