P4P MD
Here in Massachusetts, Blue Cross Blue Shield of Massachusetts continues its progressive stance on healthcare with new pay-for-performance (P4P) incentives. This comes not long after its $50 million technology grant for small practices to adopt EMRs (see my April 25 post, "The Wal-Mart of EMR.")
BCBSMA is spending $189 million on performance incentives this year. Though controversial and disliked by many doctors, pay-for-performance is gaining national traction. The long standard automatic payment to doctors for care is being shifted to a portion of payment contingent on quality, in the belief that it will make healthcare more cost effective. Premiums have been rising in double digits this decade.
In P4P, health insurers grade doctors and give bonuses on factors such as the number of patients who receive cholesterol testing, regular pap smears and mammograms, etc. About 13 percent of BCBSMA payments to primary-care doctors will be incentives, about $10,000 per doctor, up three percent from 2005.
In critiquing P4P, doctors frequently complain about having sicker patients or dispute third party standards. Often
doctors will boost their business volume to raise income to offset potential incentive hits. I wonder if increasing the number of patients lessens their individual time and overall care quality?
Another wrinkle: Data amassed and crunched by IT systems runs most P4P analysis. While large hospitals have IT systems with more comprehensive data, a majority of care is delivered by small and medium sized practices who lack such IT. In their case, BCBSMA uses billing data which many in the industry say lacks the necessary detail. And this may be simplistic, but if doctors get stiffed because a patient's health doesn't improve, will they start rejecting chronically ill patients?
Payors are certainly aware of these issues and are slowly working out the wrinkles. As a business practice, P4P is putting capitalist pressure on a bloated system to bring to bear quality and cost improvements, which I think is a good thing.
Tags: BCBSMA, EMR, Healthcare+PR, Managed+Care, Medical+PR, Online+PR, P4P, Pay-for-PerformancePosted by Shawn Whalen on July 19, 2006 at 1:31 PM
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