A new program unveiled Tuesday by the state's largest health insurance group will encourage state hospitals to improve patient care. This could create a financial windfall for the University Medical Center -- if University facilities can measure up to program standards.
The Quality-in-Sights Hospital Incentive Program is a three-year initiative by Anthem Blue Cross and Blue Shield to reward hospitals that meet enhanced criteria for patient safety, health outcomes and patient satisfaction.
Ron Clark, chief medical officer at the Medical College of Virginia, who served on the panel selected to draw up measurements for patient quality, said the program will complement existing efforts at many hospitals.
"The resources and focus Anthem has given will expedite" current hospital efforts, Clark said.
According to the Program Overview, goals include improving communication among caregivers, pharmacy-doctor interactions through computerized physician order entry and patient identification.
"In the health care industry, everyone is looking at quality, and by combining with colleges we can all work together to provide better healthcare," said Scott Golden, a spokesperson for Anthem's Virginia and Southeast region.
Program requirements were based on guidelines created by the Centers for Medicare and Medicaid Services and the Joint Commission on Accreditation of Health Care Organizations. Clark said it was important to set meaningful goals for state healthcare despite present quality levels.
"We're unsure of hitting targets in year one," Clark said. "But we will certainly by the third year."
Golden said Anthem wants to improve patient care for all Virginians, and state hospitals can gain financially by meeting the program's goals.
"At the end of the three-year program, hospitals could receive up to $1 million," he said.
Larry Fitzgerald, University hospital chief financial officer, said Anthem officials will monitor the hospital's performance for a 12-month period beginning July 1, 2003. If the facility exceeds the established criteria, the medical center potentially could receive $600,000 in increased payments.
Presently, Anthem payments annually represent 15.2 percent of hospital revenue or approximately $90 million, Fitzgerald said. Ten to 20 percent of MCV patients are Anthem patients.
If found in compliance with the more stringent Anthem performance goals, Fitzgerald said the increased payment level would equal 1 percent of all inpatient fees incurred each year.
Along with the University Medical Center, eight other Virginia hospitals will participate in the program, including the VCU Health System in Richmond, Riverside Regional Medical Center in Newport News and Winchester Medical Center.
Golden said Anthem has established similar programs in Kentucky, Ohio and Indiana for varying periods of time and also expects the Virginia program will be successful.
Clark said the additional funding will "help create opportunities but will not be sufficient" to fully fund often multi-million dollar hospital projects.
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