In November 1989, Congress amended the Public Health Service Act
to create the Agency for Health Care Policy and Research (AHCPR),
now known as the Agency for Healthcare Research and Quality
(AHRQ), whose responsibilities for practical guidelines reflect
congressional recognition of the need for ways to translate
knowledge into patient and practitioner decisions that improve the
value the nation receives for its health care spending (Lohr et al.,
1990, 3). Between 1992 and 1996, the AHRQ sponsored the
development of a series of 19 clinical practice guidelines.
Unfortunately, these are no longer viewed as guidance for current
medical practice and are solely for archival purposes (Agency for
Healthcare Research and Quality [AHRQ], n.d.). Currently, clinical
practice guidelines are issued by third-party organizations and are
intended for health care professionals to consider. Because value is
based on the quality and cost of health care, it is difficult to quantify
or measure quality accurately. Therefore, the interpretation of third-
party organizations will have different measures on quality.
With the differences in quality and costs, research has delved into
the standardization of clinical courses for specific needs such as knee
replacement surgery. Research has led to the concept of a joint
replacement bundle, which uses a small set of evidence-based
practices to improve patient outcomes (Wegner, 2016). It identifies
the standard-of-care treatment for medical conditions and puts a
price on the full clinical course required to provide proper health care
to patients. This approach by the Centers for Medicare & Medicaid
(CMS) provides organizations with a method of cost measurement,
which has a direct impact on the value of health care (Wegner,
2016). As a result, I do believe the government should have a central
position to guide physician practices based on cost efficiency. While
the government can develop these concepts, healthcare
organizations are ultimately responsible for applying and testing the
business model for efficacy and outcomes. Consequently, top
management of Healthcare organizations has the difficult task of
hiring individuals who can properly implement and calculate the costs
in changing Hospital cost determination as they must also consider
the traditional fee-for-service contracts (Wegner, 2016).
References
Agency for Healthcare Research and Quality [AHRQ]. (n.d.). Clinical
Guidelines and Recommendations. Agency for Healthcare Research
and Quality. Retrieved May 2, 2022,
from https://www.ahrq.gov/prevention/guidelines/index.html
Lohr, K. N., Committee to Advise the Public Health Service on
Clinical Practice Guidelines, & Institute of Medicine. (1990). Clinical
Practice Guidelines: Directions for a New Program (K. N. Lohr & M. J.
Field, Eds.). National Academies Press.
Wegner, S. E. (2016, July). Measuring Value in Health Care. North
Carolina Medical Journal, 77(4), 276-
278. https://doi.org/10.18043/ncm.77.4.276
