Value over volume


Kate Goodrich, MD, MHS, chief medical officer at the Centers for Medicare & Medicaid Services, opens HM18 on April 9 with a plenary talk focused on the rising cost of health care in the United States, and how hospitalists can be part of the solution.

Dr. Kate Goodrich of the George Washington Hospital Center in Washington, DC

Dr. Kate Goodrich

“What I want people to understand is the evolution within our health care system from one where we pay for volume to paying for value, and the role that Medicare can play in that,” Dr. Good­rich said in an interview. “Medicare has traditionally been sort of a passive payer, if you will, a passive payer of claims without a great deal of emphasis on the cost of care and the quality of care. [Now there is] a groundswell of concern nationally, not just here at CMS but nationwide, around the rising cost of care, and our quality of care is not as good as it should be for the amount that we spend.”

Dr. Goodrich said she will discuss how “that came to be, and what CMS and other payers in the country are trying to do about it.” She said the U.S. is in a “truly transformative era in our health care system in changing how we pay for care, in service of better outcomes for patients and lower costs. I would like to give attendees the larger picture, of how we got here and what’s happening both at CMS and nationally to try and reverse some of those trends.”

As value-based purchasing programs – and the push to pay for value over volume in Medicare and the private sector – continue to become the norm, the expected trend of sicker, more complex patients entering the hospital already is happening, Dr. Goodrich said. She is experiencing it in her own clinical work, which continues in addition to her role at CMS.

“I can confirm from my own personal experience [that] I have absolutely encountered that exact trend,” she said. “I feel like every time I go in the hospital, my patients are sicker and more complex. That is the population of patients that hospitalists are dealing with. That’s why we are actually in that practice. We enjoy taking care of those types of patients and the challenges they bring, both on a clinical level, but I would say also even on a social and economic level.”

Dr. Goodrich said that trend will present one of the key challenges hospitalists face in the future, especially as paying for value entails more two-sided risk.

“In a value-based purchasing world, transitioning to payments based on quality and cost is harder, because by nature the sicker patients cost more and it is harder to improve their outcomes. They come to you already quite sick,” she said. “That’s a dilemma that a lot of hospitalists face, wondering ‘How is this going to affect me if I am already seeing the sickest of the sick?’”


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