Patient Safety from the Payer's Perspective
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Transcript of Patient Safety from the Payer's Perspective
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Patient Safety from the Payer's Perspective
Strategies for Protecting Patient Safety
American Society of Law and Medicine
Suffolk University, Boston, MA
September 12, 2003
Jeffrey Kang, MD, MPH
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Role of the Regulator versus the Purchaser
• Regulators focus on mandatory structural standards and termination (or de-licensure) of unsafe providers
• Purchasers focus on driving continual quality improvement (or safety improvement) through competition
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Improving the Distribution– system change & technical
assistance
– consumer information
– non-economic incentives
– economic incentives
– compliance
FR
EQ
UE
NC
Y
1 2 3 4 5 6 7 8 9 10 PERFORMANCE (safety)
Actual50
40
30
20
10
0
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What Is Needed from Regulators
• Imposition of mandatory structural standards that have been demonstrated to improve patient safety
• Technical assistance
• Mandatory reporting of “never events” - including revealing the patient
• Mandatory profiling on standard measures in the aggregate without revealing the individual patient and with peer protection
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The Role of Purchasers
• Stop paying for “never events” (note: this begins to move us from fee for service to “fee for outcome”)
• Member education with or without incentives to go to safer providers
• Non-economic incentives for providers who profile as safer
• Economic incentives for providers who profile as safer
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Member Education and Incentives
• Payers tend to interact with members late in the decision-making process so a member education approach not likely to be effective
• Differential cost-sharing (or waiving of cost-sharing) for those members who go to safe providers maybe more effective but difficult to administer
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Non-economic Incentives
• Administrative relief
• Improved claims processing and cash flow
• Patient volume through education, referral, and incentives
• Patient volume through network restriction (requires public acceptance that not all providers are equally safe)
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Economic Incentives
• Rewarding Performance - adding more money into the system and paying more for safer providers
• Performance guarantees - contracting with providers to guarantee performance in order to maintain existing payment levels
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Questions or Discussion