The federal government wants to find the incentive that will convince doctors to participate in its pay-for-performance programs.
According to Thomas B. Valuck, MD, medical officer and senior advisor for the Centers for Medicare & Medicaid Services, CMS will administer a recently-legislated 1.5 percent incentive to physicians that participate in a new pay-for-performance plan patterned after the one already in place for hospitals. However, CMS knows that 1.5 percent is just a start, Valuck said, and that a bigger incentive might be needed.
"For hospitals, it was a 0.4-percent incentive that motivated participation," Valuck told participants at a Dec. 14 Webinar hosted by Reardon Consulting and the National Association of Certified Valuation Analysts. "This shows how tight margins are if 0.4 percent is seen as significant incentive for hospitals."
It could take as much as 20 percent to motivate physicians, he said.
On Dec. 9, Congress approved a 1.5 percent pay increase, beginning in the second half of 2007, for physicians who submit data to CMS on applicable quality measures. The incentive necessitates that physicians report their information using information technology.
Valuck said it will be difficult to estimate the impact the incentive will have on physicians given the number of variables in the revenue picture. "The problem with the 1.5 percent incentive is that doctors will raise the question, 'Does $1.50 on $100 of billing cover the costs of reporting?'" he asked.
Mark L. Ashlock, a certified public accountant and principal with Ashlock & Valentine, has had experience with hospitals that have participated in pay-for-performance plans. "Most hospitals are seeing this as the wave of the future," he said at the Webinar, "but participation requires infrastructure to support electronic medical records, and most hospitals cannot offset the cost of implementation without participating in some sort of demonstration project."
Ashlock warned hospitals and doctors alike to remember that many electronic health record systems are not created with pay-for-performance in mind. Special queries or side-by-side programs are often needed to track required data, and electronic health record systems will need to be compatible with billing systems.
For the most part, "we're not there yet with having systems in place," Ashlock said.