Value Based Purchasing and Measurements

What does Hell, Michigan have to do with value based purchasing?  Maybe nothing.  George Reeves was quite the entrepreneur until... well, until after the Civil War and the government raised taxes on whiskey to such a degree that Reeves wouldn't be able to sell his whiskey and make a profit.  Reeves and the locals believed whiskey was valuable, so they came up with a scheme to keep whiskey production alive by working as a community, sinking barrels of whiskey in the pond and lying to tax collectors.  I'm really not condoning lying to government officials or short changing the IRS on taxes, the Hell, Michigan saga is just a great little story highlighting what a group of people did too keep something they believed of value in their lives.

With Value Based Purchasing, I ask myself who determines value?  Various stakeholders will have their own perspective on "value."  Is it the government, consumers, employers, third party payers?  I would hope providers would have a large role in assisting with defining value, setting realistic standards and offering insight into processes.

Of course CMS is on a value kick.  I'm not knocking value.  I think not only knowing the services provided, but also the quality of the services, is good to know.  We do this with a lot of items we purchase, so it is reasonable for healthcare services to receive the same scrutiny.  Granted, when I read page 6 of the CMS document and think about point number 2 and then see point number 6, I do have to scratch my head.  PQRI aren't measures or even measurements, are they?  I think PQRI are more like a checklist... How does my personal PQRI list look to you?  Seriously, does it look like a measurement or a list? Measurements aren't really things you can say yes, I did it or no, I didn't do it.

What got me all thinking about value and determining value and measurements was an article I read.  Comparing the Performance of EQ-5D and SF-6D When Measuring the Benefits of Alleviating Knee Pain uses PQRI *real* measurement tools to capture the benefits and cost effectiveness of interventions.  For our profession, PQRI have nothing to do with the quality of the services provided because PQRI don't capture outcomes.  In the study listed above, I'm not sure if utility indices using scales from death to full health are the appropriate types of tools to utilize for the services we provide.  My rationale lies solely on what treatment strategies are being compared.  I would think that surgery would have a higher probability of risk (because you can die from surgery, you can have further life-threatening complications, you can have infection, you can have surgical failure) in not being as cost-effective as non-invasive treatments, such as physical therapy services.  What happens if you put physical therapy services head to head with massage therapy?  I have no idea... But, a huge risk, in my opinion, is if physical therapy services are put head to head with treatments encompassing education, advice and brochures.  Will physical therapy be deemed more cost-effective than the lowest level of intervention?  Will economic professionals really use the right tools to give them the best information?  What say do we as providers have in this journey of determining cost-effectiveness?

The devil is in the details...

~Selena