Assessing quality in alternative payment models

Within an alternative payment model, the focus of both the payers and the providers is on reduction of cost in providing care. Both the payers and the providers must, however, meet the moral, ethical, and legal requirement to show that quality was maintained, or, more ideally, improved for having gone through process changes. Being episodic, total joint arthroplasty is better suited for bundled payment models. This article reviews types of performance measures, their current application in the CMS value-based purchasing (VBP) and CJR programs, future measures and applications, and potential unexpected consequences and their possible solutions.