Creating incentives in the payment system to reward quality of care rather than just the quantity of procedures.

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"The concept of a payment policy that supports quality and safety is something that we support, " says Nancy Foster, who handles quality and patient safety issues for the American Hospital Association.

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It includes a historic commitment to comprehensive health care reform, a down payment on the principle that we must have quality, affordable health care for every American.

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It includes a historic commitment to comprehensive health care reform a down payment on the principle that we must have quality, affordable health care for every American.

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The feds may be zeroing in on similar lapses in methodology in rating complex mortgage-backed securities, which got their triple-A ratings not because of the quality of the underlying assets in the case of subprime mortgages, that quality stank but because of their structure that guaranteed payment to higher tranches of securities at the expense of the lower.

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The State Innovation Models initiative makes awards to states that seek to design and test multi-payer payment and delivery models that seek to deliver high-quality health care and improve health system performance.

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For example, you can get a colonoscopy in three places, each location with very different cost reimbursement structures, but it is hard to ensure if the quality of care is necessary to account for three different levels of payment.

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Not only does the move toward direct payment have the potential to reduce health costs it could also yield higher-quality care.

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