No amount of incentive will entice physicians to participate in a quality data submission program if they are hesitant about pay for performance (P4P), according to Chris Weiss, president and CEO of Hanover, N.H.-based Dynamic Clinical Systems.
On December 9, Congress passed a measure that will include a 1.5 percent pay increase - beginning in the second half of 2007 - for physicians who voluntarily submit data to the Centers for Medicare & Medicaid Services on applicable quality measures.
"Doctors are afraid of private payers and they want control over the care they give," Weiss said.
DCS is a patient- centered, online electronic medical record company founded out of a connection with Dartmouth College and its teaching hospital, where, well before federal discussion of P4P, "a growing number of enlightened doctors wanted to understand how well they are doing," said Weiss.
Weiss said CMS would be better off luring doctors with a reward for initially setting up a reporting system, then allowing up to 12 months for data submission. Such an approach might help to give doctors confidence in the system, Weiss said.
The federal government has made it clear that it anticipates P4P to play a big part in overhauling the American healthcare system. At a November summit of healthcare IT business stakeholders, Department of Health and Human Services Secretary Michael Leavitt said a market based on consumer value is the only way to change. "Every patient has a right to see quality of care, based on information and standards that experts agree upon," Leavitt said.
Leavitt also said physicians will have to begin thinking about the entire cost of treating a patient. "Without understanding the consequences of the entire cost of an episode of care, practitioners lose touch with value," Leavitt said.
At a Dec. 15 P4P meeting held in Washington by the Alliance for Health Reform and the Commonwealth Fund, Stuart Guterman, senior program director of the Commonwealth Fund's Program on Medicare's Future, said the U.S. already pays for performance, but it pays for the most complicated performance.
"[Medicare] doesn't ask whether those services are better or more valuable," Guterman said. "You have to remember that you do get what you pay for and the objective of pay-for-performance is to start paying for what you want rather than pay for more of whatever happens to be provided."
Gail Wilensky, senior fellow at Project HOPE and former chair of MedPac, the advisory panel to Congress, said there is no "magic bullet" or "silver panacea" for reforming the healthcare system.
"Many steps will be needed to be taken in order to remedy the problems in Medicare," Wilensky said at the Dec. 15 meeting. "[T]rying to change the reimbursement system using this among other mechanisms is one strategy."