Holding Providers Accountable for Health Care Outcomes

Jacob Korula

doi:10.7326/L17-0707

Letters |3 April 2018

Holding Providers Accountable for Health Care Outcomes

Jacob Korula, MD

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TO THE EDITOR:

Baker and Chassin (1) provide an excellent assessment of the value of outcome measures—the yardstick payers use to evaluate physicians and hospitals accountable for delivering care. This achievement is particularly remarkable, because their commentary seems to be viewed from the perspective of The Joint Commission. I would like to raise some questions to better understand the applicability of the data for accountability programs.

First, the authors are correct that the time for each measure defined by diagnosis codes should not be fixed to 30 days. Rather, it should be tailored to specific disease severity. The International Classification of Diseases, 10th Revision, codes used in claims data do not reflect severity or comorbidity; thus, databases predicated to these determinations are flawed. For example, a patient with stage A heart failure (I50.9) and hypertension (I10.0) living with family and a patient with stage D heart failure (I50.9) and poorly controlled diabetes mellitus (E11.9) who is blind (H54.8) and an amputee (Z89.9) and lives alone would have almost similar claims data; however, the latter is more likely to return in 30 days for various obvious reasons.

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2018 American College of Physicians

Letters |3 April 2018

Holding Providers Accountable for Health Care Outcomes

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Letters |3 April 2018

Holding Providers Accountable for Health Care Outcomes

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