Today there is hardly a more hotly debated topic than pay-for-performance, or P4P. And yet, despite all the brouhaha, it’s still only a distant speck on the horizon.
In line with the Bush Administration’s push for value-driven, transparent healthcare, the government has alluded to one day paying doctors entirely on performance.
As a start, on April 3 the Centers for Medicare & Medicaid Services released information on how doctors will be measured for quality performance under the now voluntary 2007 Physician Quality Reporting Initiative.
The list of 74 measures to be used in the initiative includes aspects of treatment and screening for Medicare patients with diabetes, heart disease, depression, stroke, glaucoma, cataracts, osteoporosis, melanoma, end-stage renal disease, asthma and pneumonia – to name a few.
According to a law passed last December, doctors who measure and report their performance based on the measures from July 1 to December 31 this year will receive a bonus payment of 1.5 percent of their total allowed charges under Medicare.
Despite this incentive, many industry experts predict that P4P won’t take off any time soon. First, doctors fear being publicly misrepresented by faulty data. Second, even if they weren’t afraid of misrepresentation, most doctors don’t have the information technology necessary to capture the data they need.
Recent surveys paint the picture.
A HIMSS Analytics and QuadraMed survey released in February said most healthcare organizations are aware of the need to collect quality and performance measures, yet only 30 percent are ready for pay-for-performance reporting. The report was based on a survey of 300 chief operating and financial officers, nurse and physician executives and senior information technology executives.
Another survey, released March 15 in The New England Journal of Medicine, raises concerns over the effectiveness of a potential P4P program. The study shattered the assumption that Medicare costs are being contained because one physician mainly manages a patient’s care. It found that the majority of Medicare patients see two primary care physicians and five specialists working in four different practices.
Researchers from the Memorial Sloan-Kettering Cancer Center and the Center for Studying Health System Change, which conducted the study, asked a key question – which doctor should get the P4P incentive when a patient sees more than one?
Meanwhile, an April 10 report published in Health Affairs warns that P4P could lead to increased healthcare disparities among minorities and the poor.
It’s clear that P4P won’t happen overnight, and the programs will require careful crafting and lots of work if they are to achieve the desired effect.