Recent publicity surrounding a contractual negotiation dispute between Medibank Private and Calvary Healthcare has shone the light firmly on the issue of clinical quality outcomes in the private hospital industry and the notion of pay for performance.
It is a major concern that recent comments in the press by Medibank Private, and Private Health Care Australia representing the health insurance industry, have strongly intimated that clinical quality outcomes in the private hospital sector are sub-standard.
Nothing could be further from the truth. The Australian Institute of Health and Welfare reported that from 2013-14 data, there were less adverse events reported in private hospitals (4.1% of separations) versus public hospitals (6.7% of separations).
Furthermore, the Australian Commission for Safety and Quality in Healthcare (ACSQHC) has publicly supported the proactive approach that the private hospital industry has been taking in ensuring a focus on measuring, reporting and improving clinical outcomes arising from a hospital admission.
Medibank Private’s list of ‘highly preventable adverse events’ has been deemed by the Commission as “not fit for purpose”, with many of the items on the list representing complications of treatment rather than ‘preventable adverse events’.
Professor Picone, CEO of the ACSQHC, has publicly stated that Medibank Private “would be very unwise to proceed with its list … as it is based on inaccurate information”.
The Australian Medical Association and some of the professional medical colleges have openly criticised Medibank’s approach as misguided and ill informed.
Additionally, Medibank’s proposed 28 day readmission rule creates significant difficulty for hospitals to be confident to continue treating patients with chronic medical conditions who often carry multiple co-morbidities, due to the increased risk of non-payment.
Experience internationally around pay for performance has been mixed. However, one issue that has proved important has been the need to have a combination of financial incentives as well as penalties.
Rewarding a hospital for consistent achievement of quality outcomes above an agreed benchmark creates a more positive mindset than one which relies solely on penalties, and also adds incentive to continually improve benchmarked outcomes.
Given the desire by private hospitals to ensure quality outcomes, and the detailed work that many private hospitals are undertaking with the ACSQHC to further develop reporting indicators and drive further quality improvement, it is vital that any work on clinical outcome data lists should be undertaken by the Commission.
They will ensure appropriate engagement with the medical practitioners and the broader health industry.
Richard Royle is the executive director of UnitingCare Health and the current president of APHA.