Improving Performance, Not Just What's Measured: Does the Inpatient Prospective Payment System Provide Useful Lessons?

Abstract

The interesting article by Averill and colleagues succinctly makes the case why the aspiration for using payment reform to improve health care value has gotten off track, namely, that instead of focusing on actually getting more value, policy has focused on an increasingly complex attempt to measure value. But instead they undermine that insight by recommending their own favored measures for use in pay-for-performance. Without question, their potentially preventable events concept as the target for measurement not only is an improvement over current and Congressionally mandated ones but also presents undiscussed measurement complexity. I argue that the lessons of the successful Inpatient Prospective Payment System they detail do not support their rationale for endorsing even a better version of pay-for-performance.