Medicare Explores How to Pay Doctors for More Effective Care
Under a new program from the Centers of Medicaid and Medicare, doctors in solo and small medical practices will soon be eligible for up to $10,000 more a yearif they can demonstrate that their performance is up to snuff.
Among other criteria, doctors will be evaluated for the percentage of diabetic patients whose glucose is under control and who are getting appropriate foot and eye exams.
Physicians will also report on the percent of high-risk patients referred for immunizations and cancer screenings, and on the medications that heart failure and coronary artery disease patients receive.
The program should begin next year, with pilot studies in about 800 practices in Arkansas, California, Massachusetts and Utah.
Data reporting requirements of P4P (pay-for-performance) programs usually make health IT necessary, and these states were previously part of another CMS pilot program to help small physician offices adopt electronic health records and other information technology.
Jim Morrow, a community physician in Georgia and occasional consultant for EMR vendor AllScripts, said the program could change some doctors minds about adopting health IT.
"I believe that this will really help them because money is the biggest issue," he said.
In fact, if the P4P rewards were recurring, he said, such programs could mean that technology would pay for itself over several years.
The CMS announcement comes less than a month after the Institute of Medicine issued a report finding that the current system encourages doctors to provide more care rather than more effective care.
However, the Centers for Medicare and Medicaid had previously rolled out programs for hospitals and large physician practices. But because most patients receive routine care in small community practices, the effects of this program could be more widespread.
Though participating doctors will still be paid on a fee-for-service basis, they will get additional reimbursement for Medicare based on how they help patients manage chronic diseases and whether they encourage preventive services.
The first year, however, doctors will be paid more just for reporting the information. This will help work out glitches in data collection and provide a baseline for future performance.
After that, physicians could earn yearly bonuses of up to $10,000 per physician and $50,000 per practice. The pilot program is scheduled to last three years.
The CMS first implemented a pay-for-performance program in over 260 hospitals. It pays participating hospitals up to 2 percent more for meeting certain straightforward quality measures such as administering antibiotics quickly or making sure that all heart attack patients receive aspirin.
At the first conference dedicated to P4P in health care this year, experts said that only large financial rewards, on the scale of a tenth of a physicians pay, were likely to make a difference.
However, CMS has reported that early results from the hospital program indicate that care has improved.
According to Morrow, $10,000 would be a tenth of a physicians income for many general practitioners across the country, particularly those in rural areas.
A complete list of the measures for the newest project is available on the href="http://www.cms.hhs.gov/DemoProjectsEvalRpts/MD/list.asp">demonstration Web site.
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