title: Aligning quality and payment for heart failure care: defining the challenges.
abstract: Hospitals may not support programs that improve the quality of care delivered to heart failure patients because these programs lower readmission rates and empty beds, and therefore further diminish already-declining revenues. A conflict between the highest quality of care and financial solvency does not serve the interests of patients, physicians, hospitals, or payers. In principle, resolution of this conflict is simple: reimbursement systems should reward higher quality care. In practice, resolving the conflict is not simple. A recent roundtable discussion sponsored by the Heart Failure Society of America identified 4 major challenges to the design and implementation of reimbursement schemes that promote higher quality care for heart failure: defining quality, accounting for differences in disease severity, crafting novel payment mechanisms, and overcoming professional parochialism. This article describes each of these challenges in turn.
mesh_terms: D003695:Delivery of Health Care / Q000191:economics; D006333:Heart Failure / Q000191:economics* / Q000628:therapy*; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics*; D011787:Quality of Health Care / Q000191:economics*; D014481:United States