WASHINGTON – Provider groups are behind the curve when it comes to anticipating acceptance of pay-for-performance programs, Jeff Flick said at a health care congress sponsored by the Wall Street Journal and the CNBC.
Take, for instance, the Premier Hospital Quality Incentive Demonstration program funded by the Centers for Medicare and Medicaid Services, under which hospitals report data on 34 quality measures, said Mr. Flick, the CMS regional administrator in San Francisco. The program gives a bonus each year to the 20% of hospitals with the highest score, but those who have not improved a certain amount after 3 years are penalized.
When the program was launched several years ago, “The American Hospital Association said, 'No hospital is going to do this,'” Mr. Flick said. “But there were 300 hospitals on board immediately.”
Similarly, the American Medical Association recently said it did not support CMS's new physician voluntary reporting program, under which physicians would report 36 pieces of data on their practices.
The AMA's opposition “is not a shock; those kinds of organizations are very nervous about this,” said Mr. Flick. “But it is a very important step that CMS is taking, and it is physicians saying, 'I want to report information because I'd like to know if my performance varies in a significant way from my peers.'
Many physicians are ready to start focusing on quality, he continued. “They want to publish information, they want to know how they compare, they want to be paid based on performance.”
The program uses “G codes” to enter the data, which can make for a bit of a hassle for those unfamiliar. “If every physician in this country had an [electronic health record], this would be easy; I think this would be done,” he said.
Other projects demonstrating pay-for-performance include:
▸ Group Physician Practice. Large multispecialty practices will be rewarded financially for improving care for chronically ill Medicare patients.
▸ Coordinated Care. Hospitals and other health care organizations in 15 sites are trying to prove that providing coordinated care for patients with particular chronic illnesses will increase patient satisfaction and save Medicare money.
▸ Benefits Improvement and Protection Act (BIPA) Disease Management. This program coordinates care and provides a prescription drug benefit for up to 30,000 patients with diabetes, congestive heart failure, and coronary artery disease.
“Watch the demonstrations–watch them very carefully,” Mr. Flick said. “They give a very good picture of where CMS thinks it's going to go.”