Understanding the Issues 2008: Health Care

[Schneed10]

Originally Posted by dmek25

schneed, its funny you mention the companies blue cross and aetna. from 1999 until 2006, i had blue cross, that was company provided. last year our company switched to aetna. i never thought that much about it until i got a phone call from my brother. he said aetna is the worst. refuses to pay on just about everything. this year our company switched back. one of the big wheels wives got really sick. and aetna fought them tooth and nail over everything. thus the switch. you talk about compensating providers based on quality. in theory, this is a great idea. in reality, who makes this call? or is this another way for some one to make a ton of money for giving good marks to some providers that don't really deserve it? if its someone involved in the insurance industry that will be doing the grading, it definitely isn't going to work

Dmek, with all due respect, you apparently know nothing on how pay for performance works. Quality is not "judged" or "graded" by someone who comes in and peeks under the hood of your hospital. It is judged by hard numbers standardized within the industry:

- % of people dying compared to the expected death rate
- % of patients receiving unplanned return to surgery
- % of patients discharged within a predetermined time frame appropriate for their illness

You either meet those numbers or you don't, it's not subjective. If you meet them, IBC and Aetna give you a 5% increase on your reimbursement rates next year. If you fail, they only give you a 2% increase. Cut and dry. It's widely regarded as one of the best innovations to come about in healthcare reimbursement recently.