First pediatric hospital signs on to global payments
Children's Hospital Boston joins Blue Cross' alternative quality contract
Topics: Reimbursement, Finance, Accountable Care, Market Trends, Strategy, Health Care Reform, Pay-for-Performance
January 26, 2012
Children's Hospital Boston has joined Blue Cross Blue Shield of Massachusetts' (BCBSMA) global payment model, making it the first pediatric-only hospital in the country to agree to the alternative payments, the Boston Globe reports.
Under BCBSMA's Alternative Quality Contract (AQC), physicians are paid a fixed amount per patient regardless of the actual cost of care. The contract includes financial incentives for meeting quality goals and cutting costs. In October of 2011, Partners HealthCare, which operates Massachusetts General Hospital and Brigham and Women’s Hospital, signed on to the insurance giant's AQC.
However, Children's was not expected to join the AQC because some specialty hospital leaders say the contract is weighted toward adult care, the Globe reports. To address the issue, BCBSMA and Children's crafted new quality measures to assess clinical outcomes more relevant to pediatric care. For example, Children's physicians will be evaluated on how well they treat young cystic fibrosis patients and how they prevent complications following appendectomies.
BCBSMA President and CEO Andrew Dreyfus called the deal "a significant milestone in our efforts to make health care more affordable while improving our members' care." He adds that it "validates that our payment model can work for a variety of provider organizations—hospitals, specialty groups, and smaller physician practices—that want to collaborate to improve quality and outcomes while slowing the rate of spending."
As part of the three-year deal, which also includes the Children's Physicians Organization and the Pediatric Physician Organization at Children's, the hospital will receive no rate increase in 2012. In 2013 and 2014, the 395-bed hospital will receive a slight increase of less than 3%. "The contract is completely aligned with our aggressive and comprehensive efforts to take costs out of the system, while improving quality," says Children's President Sandra Fenwick (Weisman, Globe, 1/24; BCBSMA release, 1/24).
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