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VINTAGE: Pay-4-Performance Healthcare

16 Responses

1. Anonymous, on October 16, 2007 at 6:02 PM said:

   CMS Announces New Income-Based Premiums

   Forget about P4P for the providers; just look what CMS just did to MC patients based on income.

   While the standard monthly Medicare Part B premium in 2008 will remain less than $100, the roughly 5% of individual and married enrollees with higher incomes will pay more if they choose to remain in the outpatient program.

   Individual income Joint income Premium

   Less than $82,001 Less than $164,001 $96.40
   $82,001-$102,000 $164,001-$204,000 $122.20
   $102,001-$153,000 $204,001-$306,000 $160.90
   $153,001-$205,000 $306,001-$410,000 $199.70
   More than $205,000 More than $410,000 $238.40

   Source: Centers for Medicare & Medicaid

   Now, what say ye?

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2. Joseph, on October 28, 2007 at 1:03 PM said:

   Cart Before the P4P Horse?

   Sorry senior patients, but MC premiums are a bargain.
   So, let’s not put the cart before the P4P horse.

   According to Stephen Beller PhD, of National Health Data Systems Inc, something must be done to increase the value (cost-effectiveness) of medical care delivered to patients in our broken healthcare and unsustainable Medicare model.

   Beller suggests that the problem with today’s pay-for-performance [P4P] and no-pay-for-poor-performance initiatives is a cart-before-the-horse issue for which there is a solution–one that requires a shift of focus and priorities, and to stop pretending we know more than we do.

   Instead of pretending, we should be obtaining and using the knowledge we need by investing more in clinical research (in both lab and field) and advanced information systems that provide next-generation decision-support, collaboration, and continuity of care capabilities.

   He recommends that our focus be on transforming the current healthcare system to a value-based system that pays for the research, collaboration and information systems needed to establish, evolve, disseminate and use evidence-based guidelines that are tailored to each patient’s particular needs.

   Financial incentives then should go to the providers who engage in this knowledge-building and utilization process, rather than simply rewarding those who follow today’s inadequate guidelines.

   Once valid and reliable patient-specific best practice guidelines are established, some pay for performance (P4P) makes sense. If premature with P4P however, we might actually do more harm than good, as we risk lulling ourselves into a false sense of security.

   Any thoughts?
   Joseph

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3. Dr. Marcinko, on October 28, 2007 at 1:22 PM said:

   Reimbursement Alternatives!

   Readers might wish to check out this related article:
   http://content.nejm.org/cgi/content/extract/357/15/1547
   in the New England Jouranl of Medicine.
   It points out two potential future reimbursement changes.

   1. One, is to not pay for medical mistakes.
   2. The other is to not to pay for lack of performance (British initiative).

   Your informed thoughts are appreciated.
   -Dr. Marcinko

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4. Ann, on October 29, 2007 at 4:41 PM said:

   P4P Benefits versus Costs?

   Q: Are the benefits of pay-for-performance programs worth the cost and hassles to provider organizations to participate.

   Answer: A recent poll by Health Data Management suggests to-date:
   Agreed = 306 [42.21 %]
   Disagreed = 419 [57.79 %]

   Feel free to opine relative to your own healthcare organization.
   -The Moderators

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5. A Reporter, on November 7, 2007 at 11:36 AM said:

   Zagat to Rank Doctors

   Zagat Survey and WellPoint will soon allow consumers to rate physicians. In the next several months, an online physician ranking guide based on patient input to more than one million members will be released. The guide will rank physicians based on trust, communication, availability and office environment on a 30-point scale. The guide also will include patient comments. At least 10 responses about a physician will be required before any information is posted.

   WellPoint plans to roll out the survey to all of its 35 million members. Physician ranking sites provide transparency and are part of consumer-driven health and P4P initiatives, according to some experts.

   Source: Chicago Tribune via American Health Line [11/6/07]

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6. An Accountant, on November 15, 2007 at 11:47 PM said:

   Blue Cross / Shield “Never-Events” and P4P?

   According to Kevin Shanklin, executive director at the Blue Cross and Blue Shield Association, discontinuing payments for NEs may take several years as coding rules are updated to make them easier to identify in claims. And, although no Blues plans are denying payments for never events currently, some will be moving more quickly than others to discontinue payments.

   #1: So, do you believe that other insurers will adopt similar policies?

   #2: Should the Blues be “taken-to-task” for procrastination with the obvious?

   #3: Finally, how should NEs affect P4P initiatives?

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7. Hope, on November 29, 2007 at 5:54 PM said:

   Good P4P post and comments, all.

   Now, check out this link for additional opinions and a closer look
   from the medical profession.

   http://www.arthritispractitioner.com/article/7684

   Best.
   Hope

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8. Ann, on January 28, 2008 at 9:25 PM said:

   According to Anthony Guerra, Editor-in-Chief of Healthcare Informatics magazine, CMS’s latest P4P and HIT initiative to only reward better patient outcomes that are achieved using Electronic Medical Records [EMRs] is somewhat Machiavellian?

   And so, what do you think of these rules – which admittedly lack clarity to date?

   -Ann Miller; RN

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9. Dr. Pruitt, on May 1, 2010 at 1:49 AM said:

   Pay for Performance in Dentistry

   For readers who are interested in how quickly quality assessment of dental care in the nation is progressing, on Wednesday, a paper was posted on 7th Space titled “Pay for performance: will dentistry follow?” (by Andreea Voinea-Griffin et al)

   http://7thspace.com/headlines/342745/pay_for_performance_will_dentistry_follow.html

   The paper begins: “’Pay for performance’ is an incentive system that has been gaining acceptance in medicine and is currently being considered for implementation in dentistry. However, it remains unclear whether pay for performance can effect significant and lasting changes in provider behavior and quality of care…”

   Andreea Voinea-Griffin et al have no idea.

   The clueless authors then explore only a few of the factors that they determined complicate the national adoption of carefully planned, “value-based purchasing programs” in dentistry that are designed by software experts to replace the uncontrollable, low-tech free market system based on finicky, uninformed patient preferences. After all, depending on “gut feelings” about one’s healthcare provider is tens of thousands of years old and hardly scientific.

   Stakeholders both inside and outside our own ADA – many of whom lead in the promotion of Evidence-Based Dentistry – feel that dental patients need government help to not only distinguish a good dentist from a bad dentist, but to save everyone money in dental care by forcing dentists to provide the highest possible quality for the lowest possible price.

   Without even mentioning how revolting their system will be to thinking Americans, here are some of the complicating factors that the authors cite which they say still must be overcome before the dental market can be controlled by computer experts for the common good:

   – Variations in dental care

   – Lack of development for evidence-based dentistry

   – Scarcity of outcome indicators

   – Lack of clinical markers

   – Inconsistent use of diagnostic codes

   – Scarcity of electronic dental records.

   Do you see how ADA-approved evidence-based dentistry, ADA-approved coding and ADA-approved electronic dental records all play important rolls in the quality-controlled dental market of the future? Even though you won’t be able to get an ADA official to discuss their eDR plans with you unless you are a fellow officer or stakeholder, our dues are quietly funding the development of pay-for-performance in the nation.

   Let me ask you something, dentists. Do you have an NPI number? Did you ever wonder about the real purpose of the permanent 10 digit number that the ADA Department of Dental Informatics persuaded you to volunteer for, but was reluctant to discuss? When your ADA leader assured you that signing up for the NPI was the right thing to do, I bet you trusted him, didn’t you. Will you ever trust him again, or did he blow it by betraying your trust?

   The authors conclude: “Although none of these factors were essential deterrents for the implementation of pay for performance programs in medicine, the aggregate seems to indicate that significant changes are needed before this type of program could be considered a realistic option in dentistry.” And American dental patients’ welfare is protected from e-Avarice for a little longer.

   I couldn’t help but notice that among Voinea-Griffin and her 5 et als, not one thought to mention tens of thousands of other tricky problems with their plans for a perfect society – dentists can be real bastards if some bozo threatens the welfare of their trusting patients. Just try it.

   D. Kellus Pruitt; DDS

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10. Carey, on May 5, 2010 at 6:19 PM said:

    P-4-P Rising

    Philadelphia-based Independence Blue Cross just announced that it is investing $47 million to launch a new primary care physician payment program.

    http://www.healthcarefinancenews.com/news/independence-blue-cross-invests-47m-p4p-physician-payment-model

    Carey

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11. Dr. Franklin, on December 13, 2012 at 9:04 PM said:

    Docs Uneasy About Pay-for-Performance

    A new report shows that doctors have mixed views on the new pay-for-performance model promoted in the 2010 health care law as a means of controlling health care costs and improving quality.

    Click to access UNH_WorkingPaper8.pdf

    So, shall we say good-bye to FFS medicine?

    Dr. Franklin

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12. D. Kellus Pruitt DDS, on March 15, 2013 at 10:04 AM said:

    P4P is Here

    Almost a decade after President George W. Bush discussed pay for performance (P4P) as a possible solution to wasted healthcare dollars, P4P has finally arrived for physicians. Unless the effort fizzles, it looks like dentists’ pay will be largely determined by patient satisfaction.

    According to Dike Drummond, MD, in his article posted today on KevinMD, the grading algorithm is to be weighted in such a way that only a small minority of providers who provably make dental patients the happiest will receive an A on their report card – qualifying them for the highest pay scale managed care offers … which will still be below the average fee-for-service price. What do you expect? When one gambles, the house always gets their cut. (See: “The key for patient satisfaction is physician [and staff] satisfaction”).

    http://www.kevinmd.com/blog/2013/03/key-patient-satisfaction-physician-satisfaction.html

    Dr. Drummond shares information concerning:

    – How your performance will be measured

    – How to get the highest patient satisfaction scores and be a happier doctor at the same time

    – The first step to improving performance (in a healthy way) for you and your organization

    It might be a good time to brush up on people skills, Doc.

    D. Kellus Pruitt DDS

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13. Hope Rachel Hetico RN MHA, on December 10, 2013 at 10:53 PM said:

    P4P

    Does it ignore human motivators?

    http://wingofzock.org/2013/12/10/pay-for-performance-programs-ignore-true-human-motivators/

    Hope Rachel Hetico RN MHA

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14. Gregory Adams, on December 24, 2013 at 9:40 AM said:

    Understanding Value-Based Purchasing Payment Models

    As we know, the term hospital reimbursement means compensation for any type of related hospital services.

    For more info: http://www.hfma.org/

    Gregory Adams

    The Healthcare Financial Management Association (HFMA) values and respects diversity. Learn tips to improve reimbursement performance in HFMA’s Payment & Reimbursement Forum.

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15. Ann Miller RN MHA, on October 10, 2014 at 6:00 PM said:

    Payment Reform Puts Medical-Device Industry on the Defensive

    Medical technology companies are warning that burgeoning pay-for-performance and risk-based reimbursement models will motivate providers to block access to clinically important innovations. Healthcare economists and quality experts, though, counter that the new models appropriately put the onus on manufacturers to prove that their products are worth the cost.

    Diana Zuckerman, a researcher who has been critical of the Food and Drug Administration’s procedures for approving and monitoring medical devices, said the industry isn’t accustomed to having to prove that a product is cost-effective. “Something can be clinically appropriate and not be necessary,” said Zuckerman, who is president of the National Center for Health Research.

    Source: Sabriya Rice, Modern Healthcare [10/7/14

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16. Darrell Pruitt DDS, on June 1, 2015 at 7:06 PM said:

    Opposing opinions on Pay-for-Performance in healthcare

    “With accountable care organizations and various kinds of patient-centered medical homes, we are starting to develop quality registries and interoperability…. You are going to be paid for outcomes—keeping people healthy. You can’t do that unless you’ve implemented IT effectively. I love the idea of payment based on outcomes.” – John Halamka, MD, the Beth Israel Deaconess Medical Center CIO and co-chair of the federal HIT Standards Committee.

    (See: “Halamka: ‘Probably Time to Retire the Meaningful Use Construct.’” by Tinker Ready for HealthLeaders Media, June 1, 2015

    http://www.healthleadersmedia.com/page-1/TEC-316911/Halamka-Probably-Time-to-Retire-the-Meaningful-Use-Construct

    “Linking financial rewards to cost-effective management of patient care or reducing adverse outcomes has not produced the desired results, recent studies show. When it comes to physician pay, some experts are asking if healthcare organizations are moving in the wrong direction.” – Sabriya Rice, writing for ModernHealthcare. Dr. Steffie Woolhandler, professor at the City University of New York’s School of Public Health tells ModernHealthcare: “There is essentially no evidence that pay-for-performance works, and certainly no evidence that it works as it is being applied to American healthcare right now.”

    (See: “Physician quality pay not paying off, by Sabriya Rice for ModernHealthcare, May 30, 2015).

    http://www.modernhealthcare.com/article/20150530/MAGAZINE/305309979?utm_source=modernhealthcare&utm_medium=email&utm_content=externalURL&utm_campaign=am

    Darrell Pruitt DDS

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