WASHINGTON – Physicians may never embrace pay for performance with open arms, but they do need to get in the game.
That was the message delivered by policy experts speaking at meeting of annual research meeting of AcademyHealth.
Hospitals have viewed pay for performance “as something that is coming down the pike, and they're getting ready for that,” said Melony Sorbero, Ph.D., a researcher with the Rand Corporation.
In recent interviews conducted by Rand for studies on existing pay-for-performance programs, hospital staff expressed much less resistance than did physicians.
“Hospitals have an organizational framework, staff, and systems to be able to respond to these programs,” said Cheryl Damberg, Ph.D., a senior Rand researcher.
For hospitals, the question is how many measures are being requested and what the technical requirements are for reporting the data. For physicians, the problem is a fundamental: How will they collect the data in the first place?
“Physicians for the most part lack the infrastructure. Their data systems aren't anywhere near what hospital data systems are,” said Dr. Damberg.
However, physicians do have opportunities to get involved with the development of pay-for-performance measures. There are hundreds of pay-for-performance experiments currently engaging physicians, while only about 40 programs are aimed at hospitals, said Dr. Sorbero.
The American Board of Internal Medicine is behind one such effort targeting physicians. The organization recently completed a study to see whether physicians can be ranked based on a combination of chart reviews, patient surveys, and practice system surveys. They assessed the consistency of those data individually and together.
“We want to make sure that the measures that are going into our composites are fair and reliable,” said Rebecca Lipner, Ph.D., vice president of psychometrics and research analysis at ABIM.
The study looked solely at the treatment of hypertension, a focus that was key in formulating the patient survey questions, she said.
The questions aren't “the general 'do you like your physician?' or 'do you get good access to care?' They're all about how does the physician give care for your specific disease,” said Dr. Lipner.
However, ABIM found that there was wide variation across the sets of measures and, depending on how they were combined, an individual physician's rank could swing by more than three quartiles. For example, a physician could do well based on his chart and systems data, but do poorly on the patient surveys, she said.
One lesson may be that devising a reliable measure of physician performance is not a simple thing to do, Dr. Damberg suggested.
Another may be that physicians need a structure within which these measures become relevant. In that sense, medical homes can be seen as an attempt to give a framework to practice settings outside the hospital, said Dr. Lipner.
“A lot of what we have learned from the hospitals systems is transferring over to that medical home. But it is a big challenge. We have… quite a few physicians in solo practice. They are really by themselves, and we always underestimate how many physicians are working by themselves without an infrastructure, without peer connections,” she said.