With health care looming large over the political landscape, the 2012 GOP presidential candidates have been pressed to provide more concrete details about their health reform views. Tim Pawlenty, for one, has held Rep. Paul Ryan’s plan to voucherize Medicare at an arm’s length, recently stating that he’d support the proposal if his only choice were to sign it or do nothing. On Monday, Pawlenty tried to distance himself even further from Ryan, saying the main difference between his plan and Ryan’s is that he would change how health-care providers are paid. “It will include something called performance pay. We will begin to move providers from getting paid not just for the volume of procedures they crank out, but whether people are actually getting healthier and getting better,” Pawlenty told the Des Moines Register.
Pawlenty has yet to explain the nuts and bolts of what he has in mind. But on the surface, at least, the proposal actually seems to echo an idea that President Obama has not only supported, but also introduced as a key part of the Affordable Care Act. Under federal health reform, Medicare will link pay to performance of health-care providers for the first time, rewarding hospitals that raise “the quality and efficiency” of care. Likewise, the ACA make huge investments in ambitious pilot projects to link doctor pay to performance, all in hopes of improving care while cutting costs.
To a certain extent, it shouldn’t be surprising that there’s bipartisan interest in performance pay for providers, known to health wonks as “value-based purchasing.” The New York Times’ Robert Pear points out that both Democrats and Republicans supported a 2005 bill that first proposed rewarding hospitals for high-quality care.
But though there’s broad interest in the idea, executing it successfully is another story. Pear’s Times article explains why some are highly skeptical about how the federal government will measure hospitals for “quality and efficiency” — the ACA’s baseline definition of good performance. Though there are widely accepted measures of the quality of care, there isn’t the same consensus behind what “efficient” care means. In particular, some hospitals are worried about an ACA provision that will hold them accountable “not only for the cost of the care they provide, but also for the cost of services performed by doctors and other health care providers in the 90 days after a Medicare patient leaves the hospital.” The concern is that the standard will unfairly punish hospitals with older, sicker, and poorer patients who aren’t able to resolve their medical problems as quickly and “efficiently.”
If he continues to tout performance pay, Pawlenty could push such questions to forefront of the health care debate, bringing Obama’s specific plans under scrutiny as well as his own. (As governor, Pawlenty supported a small “performance pay” pilot program for teachers — an achievement that he proudly touts on his campaign Web site.) It’s a worthy discussion that could help shape—and potentially improve—a sweeping, largely untested idea that’s just getting off the ground.
Suzy Khimm is a staff reporter in the Washington bureau of Mother Jones.