Support grows to inject more cash into Medicare pay-for-performance (subscription required)

Those who are still unsure whether Medicare pay-for-performance should be based on rewards or penalties need to look no further than the advice that some outside the American Medical Association are giving, according to AMA Trustee John H. Armstrong, MD.

In recent testimony before the Medicare Payment Advisory Commission, witnesses representing a major insurer, a group of community health plans and a quality improvement nonprofit agreed that Congress must come up with more money to pay physicians who do well on federal quality measures — not take dollars away from those who don’t make the grade. This tacit endorsement of a major AMA policy from a widely representative panel indicates that broad-based support exists for a reward-based structure, Dr. Armstrong said.

“We believe that these other groups in health care delivery got it right,” he said. “It’s becoming apparent that the stick approach will have many consequences that hurt patient access to care. The carrot approach is one that is much more consistent with pay-for-performance programs that really want to improve quality.”

This probably represents a temporary victory for the AMA position. I strongly believe that increases in the near future will be linked to P4P. Over time, reimbursement will likely remain steady, expect for the P4P incentives – thus, implicitly decreasing payments over time for those who either do not report or who do not meet standards.

Glenn Hackbarth, the commission’s chair, responded with skepticism to Dr. Nussbaum’s assertion that pay-for-performance penalties would prompt some doctors to hold off on buying health information technology essential to improving quality.

“I’ve often heard that point made, that the physician will respond to losing money by investing less,” Hackbarth said. “I’m not sure I understand the logic of it because that means that they’re going to doom themselves to successive cycles of worsening performance relative to the leaders.”

No matter what MedPAC decides to do with the opinions from the panel and from groups such as the AMA, the commission gave no sign that it would consider abandoning the concept of pay-for-performance for another strategy that addresses quality concerns and rising Medicare costs.

The time for making that choice has passed, said commissioner Francis Crosson, MD, executive director of the physician component of Kaiser Permanente. “Pay-for-performance is one of the horses that we’ve decided to ride,” he said.

Bottom line – Medicare and private insurance will ride this horse for the foreseeable future. If you do not have an EMR, it is time to “get busy”.

Related posts:

1. Safety rather than quality
2. Can we measure quality?
3. My position on performance measures
4. Anonymous creates a strawman argument of P4P
5. Performance measure overdose

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