July – December 2007 Reporting Period
Staff Reporters
According to Anne Zieger, of Fierce Health Finance, the Centers for Medicare and Medicaid Services [CMS] will pay out more than $36 million in monetary incentives to medical providers who reported data on quality of care delivered between July 2007 and December 2007; as part of its Physician Quality Reporting Initiative [PQRI].
Physician Quality Reporting Initiative [PQRI]
Under the PQRI, healthcare providers who choose to participate get bonuses of 1.5 percent of their total CMS payments during the reporting period in which they reported quality data.
Assessment
Average payments for the most recent period range from $600 for individual physicians to $4,700 for groups. The largest payment CMS plans to make to a practice is more than $205,700. Solo physicians, physician group practices, and other PQRI-eligible professionals should receive their payments by August, according to the agency.
Source: CMS press release
Conclusion:
Your thoughts and opinions on the PQRI and related P4P performance issues are appreciated. Have you ever participated in any PQRI initiatives? Please comment.
Related Information Sources:
Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759
Physician Financial Planning: http://www.jbpub.com/catalog/0763745790
Medical Risk Management: http://www.jbpub.com/catalog/9780763733421
Healthcare Organizations: www.HealthcareFinancials.com
Health Administration Terms: www.HealthDictionarySeries.com
Physician Advisors: www.CertifiedMedicalPlanner.com
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Filed under: Career Development, Healh Law & Policy, Health Economics, Healthcare Finance, Quality Initiatives, Surveys and Voting Tagged: | CMS, P4P, physician bonus, PQRI
P4P Update
Did you know that new results from the second year of a Medicare pay-for-performance demonstration project, for large physician groups, are both raising hopes and casting doubts about the concept’s feasibility?
Ten groups that are participating in the Physician Group Practice Demonstration [PGPD], a four-year effort that began in 2005, implemented care coordination initiatives and for each year of the project can receive up to 80 percent of the savings they generate for Medicare by preventing complications and hospitalizations, reported the American Medical News, on September 8.
While all ten groups hit performance targets on at least 25 of the 27 quality measures included in the project’s second year, and five practices achieved the goals on all 27 measures, only four groups qualified for performance bonuses, which totaled $13.8 million.
Participants said the demo’s weakness is in its “efficiency” component, as CMS said the savings on care would have to exceed two percent compared with a community control group, before any payout occurs. In the project’s second year, the groups saved Medicare a total of $34 million on assigned beneficiaries, but because of the threshold, CMS recognized only $17 million, while practices also extended care coordination to Medicare enrollees outside of the project but did not receive credit for any savings generated through higher quality care of those patients.
How have you fared under the P4P initiatives; please comment.
-Ann
More on P4P
It is not hard to see what happens when stakeholders or five-year plans determine workers’ pay. Workers disappear if they live in the land of the free. As you can see from the article below written by Andis Robeznieks for ModernHealthcare.com, we appear to be on the verge of a serious shortage of family physicians. I could have grandchildren that will need doctors some day. Let’s not eat our seed corn yet. http://modernhealthcare.com/apps/pbcs.dll/article?AID=/20080909/REG/309099982/-1/todaysnews
By Darrell Pruett DDS
Primary-care pay tied to family-doc shortage: A study
Story posted: September 9, 2008 – 5:59 am EDT
Calling it a problem “that will require reform at a national level,” University of Georgia at Athens professor and Assistant to the Provost Mark Ebell concluded in the Sept. 10 issue of the Journal of the American Medical Association that there is a link between low compensation for primary-care physicians and the nation’s health.
In a study published as a “research letter,” Ebell writes that the correlation between salary and primary-care physician shortages-which, in turn, may be tied to higher all-cause cardiovascular, cancer-specific and infant mortality rates-has persisted since his original research on this issue was published in the Sept. 22, 1989 issue of JAMA and may be reaching crisis proportions.
Comparing specialties chosen by 2007 U.S. medical school graduates and salary information obtained from the American Medical Group Association, Ebell cited how family medicine had the lowest average salary ($185,740) and the lowest percentage of filled residency positions (42.1%). The specialty with the second-lowest salary, pediatrics ($185,913) had a much higher fill rate (72.8%), but the numbers for next lowest specialty followed Ebell’s thesis. Internists, with the third-lowest salary of $193,162, had the third-lowest residency fill rate: 55.9% Neurologists, with the fifth-lowest salary ($222,998), had the second-lowest fill rate at 51.9%.
In comparison, radiologists-whose average salary was $414,875-had a residency fill rate of 88.7%; and orthopedic surgeons-whose average salary was $436,481-had a fill rate of 93.8%. Ebell noted in a news release that since 2007 medical school graduates have a median debt of $140,000, debt relief for primary-care physicians could be one possible reform.
“Rising levels of student debt, considerably lower salaries in primary-care specialties, and a perception that primary care may have a less rewarding lifestyle have led to a potential workforce crisis given the aging U.S. population,” Ebell, a deputy editor of the American Family Physician journal, wrote in JAMA.
By Andis Robeznieks
55% of Docs Qualified for PQRI in 2008
More than 85,000 physicians and other health professionals shared more than $92 million worth of bonuses from the 2008 run of the Medicare Physician Quality Reporting Initiative.
Another 70,000 doctors who participated did not see any money from the effort.
Source: David Glendinning, AM News [11/23/09]
“Click for Cash”
D. Kellus Pruitt; DDS
Does anyone know of any pediatric oppurtunities such as PQRI?
Kate
Many Physician Groups Doubt Value of PQRI
Proposed changes to the Physician Quality Reporting Initiative [PQRI], the CMS’ effort to aggregate claims-based quality data and reward the physicians who submit them, are meeting with no small amount of skepticism among doctors.
For example, many physician associations and advocacy groups are also urging their members to steer clear of the error-prone, claims-based reporting mechanism altogether and to instead put their energy and resources into qualified registries or EHR-based reporting. Clinical registries collect data from their users and report performance directly to the government or other organizations.
One of the biggest issues up to this point, according to the CMS, has been the large number of physicians who participated in the voluntary program using claims-based reporting, but who failed to qualify for bonus payments. In both 2007 and 2008, only about half of the eligible professionals who submitted claims-based quality data actually qualified for payments, the CMS said in the proposed rule.
Source: Maureen McKinney, Modern Healthcare [7/26/10]
Physician Quality Reporting Initiatives
The Centers for Medicare and Medicaid Services [CMS] paid out more than $40 million in monetary incentives to medical providers who reported data on quality of care delivered between July 2009 and December 2009; as part of its PQRI.
Under the PQRI, healthcare providers who participated received bonuses of 1.5 percent of their total CMS payments during the reporting period. Average payments ranged from $750 for individual physicians to $5,000 for groups. One large practice received more than $200,000.
Dr. David Edward Marcinko MBA CMP™
http://www.CertifiedMedicalPlanner.com
[Publisher-in-Chief]
On Bonuses and Incentive Pools
Some HMO / MCOs use physician profiles to allocate funds to the top-performing physicians. The MCO may give additional bonuses or preferential allocation of incentive pool funds to physicians that perform well on particular cost-effectiveness and quality indices. Incentive pools are often built based on a certain percentage or “withhold” of dollars that are taken from the physicians’ usual reimbursement and placed in a pool. Top performers would be allocated the greatest percentage.
For example, one mid-sized health plan in the Southeast paid a 20% bonus to physicians with a case-mix adjusted performance ratio (actual/expected cost) of less than 1.3. More recently, some MCOs are integrating both quality and cost measures together for allocation of incentive or bonus payments. This type of methodology can be a basis of “pay for performance” or “P4P” methodologies where higher performing physicians receive a greater share of withhold or bonus dollars.
Dr. David Edward Marcinko MBA CMP™
http://www.CertifiedMedicalPlanner.com
[Publisher-in-Chief]
On Pay-for-Performance Initiatives
Historically, the concept of pay-for-performance (P4P) is an unproven trend, according to the Congressional Research Service, an arm of the Library of Congress. Initial studies suggest that pay-for-performance programs might change performance on quality measures that are used for the basis of bonus payments.
Claims that P4P programs are cost saving in the long run are largely speculative, however, since determining whether a certain healthcare practice produces good results usually requires controlled studies rarely possible for a social policy.
Moreover, physician pay is contingent on them believing that goals are fair, measures appropriate, performance accurately tallied, and incentives worthwhile.
Dr. David Edward Marcinko MBA
[Publisher-in-Chief]
At best, pay-for-performance as well as meaningful use are distractions.