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. “Hospitals are afraid to even report information about quality, but the idea that they could be penalized financially … the [AHA] thought it would never happen. 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 volunteer to 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,” he said.
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. That doesn't mean the AMA is going to support it.”
The program uses “G codes” to enter the data, which can make for a bit of a hassle for physicians not familiar with them. “If every physician in this country had an [electronic health record], this would be easy; I think this would be done,” he said.
Other pay-for-performance demonstration projects include:
▸ Group Physician Practice Demonstration. Large multispecialty practices will be rewarded financially for improving care for chronically ill Medicare patients.
▸ Coordinated Care Demonstration. 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 Demonstration. 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.”