The Use of Intensive Care Unit Severity Scoring Systems in Reimbursement Strategies

Abstract

In summary, there are several important aspects of the GCHQCP. First, it was not mandated by any government or agency. It is the result of a business initiative designed to reduce costs by rewarding quality outcomes and efficiency. Second, it is a collaborative effort involving hospitals, physicians, and business. This cooperation initially may have been induced by a potential threat of a loss of patients, but, nonetheless, it exists. Third, the first report includes no information about costs or charges. The GCHQCP wants the focus to be on quality of care, but, in addition, the businesses involved already know a great deal about what they are paying for health care. Future financial arrangements are much more important to those involved than the documentation of current practice. The GCHQCP has required tremendous energy and cooperation on the part of many individuals and institutions. Initiating and maintaining the project has required an unprecedented level of cooperation among groups that often have divergent interests, including business leaders, physicians, and hospital administrators. Nevertheless, the GCHQCP suggests that the monitoring of clinical outcomes using validated regression models to predict expected outcomes can assist community-sponsored programs in evaluating hospital performance in large health care systems. It is hoped that with such data, consensus can develop regarding the value of health care services to patients, payers, and providers in an arena of changing societal values and priorities regarding these services. Whatever the results of the initial release of information comparing hospitals, there are bound to be legitimate concerns regarding the methods of analysis selected. These concerns may focus on methodology, issues regarding the stratification of patient risk, or the ethical questions of what outcomes are desirable in certain subgroups of critically ill patients. If this project is successful, business, the health care community, and patient concerns will be taken into account and the evaluative process will evolve and improve. In a market-based strategy to reduce costs such as managed competition, there will be winners and losers. It is our job to develop ways to ensure that patients and those who practice quality medicine efficiently are winners.