Comments on: P4P – predictable consequences http://www.medrants.com/archives/5090 Internal medicine, American health care, and especially medical education Sat, 11 Feb 2012 15:15:48 +0000 hourly 1 http://wordpress.org/?v=3.3.1 By: solo dr http://www.medrants.com/archives/5090/comment-page-1#comment-530764 solo dr Sun, 13 Dec 2009 00:05:04 +0000 http://www.medrants.com/?p=5090#comment-530764 It takes 4 lines of CPT codes to report a diabetic's systolic BP, diastolic BP, A1C, and LDL cholesterol for Medicare's P4P for a massive 2% bonus. Blue cross sent me ratings for the last 3 years on my patients. Many of my patients need colonoscopies, but they decline when they find out it will eat at least a $1,000 of their individual $2,000 annual deductible. I then get listed as 60-70% of my patients as doing the required test. Same with a dilated eye exam for my diabetics and hypertensives. My office staff can schedule the patient to see an ophthalmologist, but the patients still won't show up and get it done.   I started doing my own lipid panels, A1Cs, and other CLIA waived labs, as about 40% of my patients were not doing their labs. My quality indicators went from the low 60s to above 95% on all my Blue Cross diabetics. A1C numbers also dropped, as I can immediately d/w my patients their glycemic control. I don't get any extra pay or bonuses from the insurance companies for this extra effort. With Medicare giving my area a 2% bonus and with fewer than 10 Medicare patient's/day, it makes sense simply to use the 20-30 minutes of quality reporting and tracking time/day to see 2 additional patients/day to increase overall revenue.   It takes 4 lines of CPT codes to report a diabetic's systolic BP, diastolic BP, A1C, and LDL cholesterol for Medicare's P4P for a massive 2% bonus.

Blue cross sent me ratings for the last 3 years on my patients. Many of my patients need colonoscopies, but they decline when they find out it will eat at least a $1,000 of their individual $2,000 annual deductible. I then get listed as 60-70% of my patients as doing the required test. Same with a dilated eye exam for my diabetics and hypertensives. My office staff can schedule the patient to see an ophthalmologist, but the patients still won't show up and get it done.  

I started doing my own lipid panels, A1Cs, and other CLIA waived labs, as about 40% of my patients were not doing their labs. My quality indicators went from the low 60s to above 95% on all my Blue Cross diabetics. A1C numbers also dropped, as I can immediately d/w my patients their glycemic control. I don't get any extra pay or bonuses from the insurance companies for this extra effort.

With Medicare giving my area a 2% bonus and with fewer than 10 Medicare patient's/day, it makes sense simply to use the 20-30 minutes of quality reporting and tracking time/day to see 2 additional patients/day to increase overall revenue.

 

]]> By: Michael Kirsch, M.D. http://www.medrants.com/archives/5090/comment-page-1#comment-530762 Michael Kirsch, M.D. Sat, 12 Dec 2009 14:39:41 +0000 http://www.medrants.com/?p=5090#comment-530762 <font color="#000000" face="Times New Roman" size="3">I agree that P4P is a sham.<span>  </span>It could be more aptly renamed, Pay for Paperwork instead.<span>  </span>The true determinants of medical quality, as in any art, cannot be measured.<span>  </span>So, the medical quality enforcers will use a bean counting approach as they gather data that is an inadequate surrogate for true medical quality.<span>  </span>They will use parameters that can be easily measured, counted and graphed claiming that this can accurately assess the medical profession.<span>  </span><span> </span>Their pie charts are pie in the sky.<span>  </span>www.MDWhistleblower.blogspot.com</font> I agree that P4P is a sham.  It could be more aptly renamed, Pay for Paperwork instead.  The true determinants of medical quality, as in any art, cannot be measured.  So, the medical quality enforcers will use a bean counting approach as they gather data that is an inadequate surrogate for true medical quality.  They will use parameters that can be easily measured, counted and graphed claiming that this can accurately assess the medical profession.   Their pie charts are pie in the sky.  http://www.MDWhistleblower.blogspot.com

]]> By: C Dahlin http://www.medrants.com/archives/5090/comment-page-1#comment-530760 C Dahlin Fri, 11 Dec 2009 16:29:46 +0000 http://www.medrants.com/?p=5090#comment-530760 I got back one of my quality evals from Blue Cross. One of the indicators was colonoscopy.The data was two years old. It only went back two years, so it did not include any done in the last five to  ten (recommended), nor did it exclude 80 years olds.It included 15 patients out of my over 2,000. It had to specifically call for the names, and by the time they came, it was the before-Christmas-using- up- my- deductible- rush we all see. What a waste of time.I scored 97-98 in mammograms, paps-68 in colonoscopy;right then you would think the generators of data might think-gee, doesn't this look odd? Pay for performance for me is NOT paying for more paperwork. I got back one of my quality evals from Blue Cross. One of the indicators was colonoscopy.The data was two years old. It only went back two years, so it did not include any done in the last five to  ten (recommended), nor did it exclude 80 years olds.It included 15 patients out of my over 2,000. It had to specifically call for the names, and by the time they came, it was the before-Christmas-using- up- my- deductible- rush we all see. What a waste of time.I scored 97-98 in mammograms, paps-68 in colonoscopy;right then you would think the generators of data might think-gee, doesn't this look odd?
Pay for performance for me is NOT paying for more paperwork.

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