Issue link: https://beckershealthcare.uberflip.com/i/774606
29 QUALITY IMPROVEMENT & MEASUREMENT Dr. Don Berwick's 3 Thoughts on the Intersection of Care Quality & Politics By Heather Punke D on Berwick, MD, said his "head is spinning" from the elec- tion, even aer months have passed since Republican Donald Trump beat Democratic candidate Hillary Clinton on Nov. 8. "We have an elephant in the room and I thought it'd be a donkey," said Dr. Berwick, senior fellow and president emeritus of the Institute for Healthcare Improvement and the former head of CMS. Dr. Ber- wick addressed a press panel at the IHI National Forum on Quality Improvement in Health Care on Dec. 5 in Orlando, Fla. "Healthcare costs…are soaring again, it's going to continue unless we change care," he said. "I read the political environment with that eye, which is — could we still change care? Is this trajectory of improve- ment going to be real or not?" Below are three thoughts Dr. Berwick shared on the election results and their potential effect on the healthcare quality movement. 1. States, private sector and individuals taking on more responsibility. Even though the administration has not yet laid out details of what it will do if the ACA is repealed, Dr. Berwick sees broad themes in possible replacements emerging, one of which is moving responsibility to the states. "One way or another, [they want to] get the federal government less active in trying to shape the financing and future of healthcare," said Dr. Berwick. "So I see states ending up with more on their plate. For patients, [it will be] in the form of more burden on them. I think for healthcare organizations it's suddenly, they're le holding the bag — the ball is in their court. I think that the euphemistic term 'personal responsibility' or 'skin in the game' is certainly part of the underlying if not explicit platforms we're seeing. I personally think that's a very dangerous way to go, but it would result in shiing cost and burden to individuals and I believe…the burden will fall heavier on people who are lower income and more at-risk." 2. Reporting requirements may decrease under the new head of HHS. President-elect Trump said he would make Rep. Tom Price, MD, the secretary of HHS, which could have an effect on pro- viders' reporting requirements, according to Dr. Berwick. "Tom Price is an orthopedic surgeon, a fan of doctors and doctor prac- tices, especially small ones," he said. "Doctors are extremely uncomfort- able with transparency, for all sorts of reasons, and I don't know which way he'll call this. I don't know if he'll say you need to have the dynamics of openness apply or if he'll say we don't want to bother, hassle physicians and therefore we'll ease up on reporting requirements." 3. Quality improvement should roll along — with cave- ats. "I think value-based purchasing — the whole idea that if the gov- ernment is going to buy care, it will be value-based — that's bipartisan. I think that kind of thinking will remain, and that helps the quality movement," Dr. Berwick said. He also sees support for ACO and bundled payment programs, as well as MACRA. "e concept that the country ought to be putting some resources into supporting experimentations, especially state-level experimentation, on new care models, I think is a good enough idea that no matter which side is approaching, it will stay. In terms of the quality move- ment itself, I think it's got plenty of gas. I don't think this will stop the quality movement." However, he did add one caveat to that — "Safety-net providers are going to be under tremendous pressure here as Medicaid support goes down [and] different ways to cover noncitizen residents will be under attack," he said. "ey're going to have to do some adjusting." n Hospitals' CMS Star Ratings Linked to Cities' Stress Level By Heather Punke H ospitals in stressed cities — cities with high poverty, unemployment rates, divorce rates and poor health conditions — tend to have lower overall star ratings from CMS than hospitals in less-stressed areas, according to a study in JAMA Internal Medicine. Researchers looked at a ranking of most and least stressed cities in the U.S., based on 27 metrics, including divorce rate, credit scores, average weekly work hours, overall health and suicide rate. They then linked 657 hospitals' star ratings to the stress ranking of the 150 cit- ies where they are located. For cities with more than one hospital, the star ratings for each hospital were weighted by bed size. Cities with a higher stress ranking tended to have, on average, hospitals with lower star ratings compared to cities with lower stress rankings. For instance, Detroit was the most-stressed city in the analysis. There, the average star rating for hospitals is less than two stars. Newark, N.J., is the ninth most- stressed city, and hospitals there have an average star rating of barely more than one star. Alternatively, Madison, Wis., was one of the least- stressed cities and hospitals there had an average star rating of nearly five stars. "On one hand, hospitals in stressed cities might provide care of lower quality on average, perhaps because of inability to invest in needed clinical or technological in- frastructure or staff shortages," the authors posited. "On the other hand, the star rating component measures may be affected by community factors such as poor transportation or limited social support services through causal pathways other than hospital quality." Study authors called further explanation into the issue "essential." n