The nation’s largest doctor group is bracing physicians for the day they will join the ranks of millions of U.S. employees who only get raises when they perform well at work.
Although not new to most workers, pay for performance is a relatively new concept to most doctors. The American Medical Association this week launched a new push to educate doctors about this concept, as employers and insurers attempt to rein in health-care costs.
In a special report to its member physicians at the group’s annual winter meeting in Atlanta, the AMA described the pay-for-performance movement as a “tsunami building offshore in a sea of stakeholder unrest, threatening those who are not prepared.”
Employers are tired of paying double-digit premium increases that go toward automatic raises for doctors and other medical-care providers without any link to performance or quality measures. As a result, private health plans and their employer clients were the first to adopt pay-for-performance initiatives.
And as the costs of the Medicare health insurance program for the elderly rise, the federal government is getting into the act.
In the second term of the Bush administration, Medicare is being targeted as one area where spending can be slowed in an attempt to rein in massive federal deficits.
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Medicare this year imposed for the first time a pay-for-performance requirement on the nation’s hospitals, giving them a full inflationary increase in reimbursement if they submit certain data measuring quality of care.
Hospitals don’t have to meet a certain score, but Medicare officials say that is likely to come in the future. The AMA expects Medicare officials to expand the initiative beyond hospitals, and physicians believe they are going to be the next target for Medicare’s pay-for-performance initiatives.
“It became apparent to us that pay for performance is not going to go away,” said Dr. Nancy Nielsen, speaker of the AMA’s policymaking House of Delegates.
Physicians say they support initiatives that can be measured, such as preventive care. Doctors, for example, could win bonuses if higher numbers of their patients were screened for colon or breast cancer and patient improvement could be measured.
But doctors say they fear pay-for-performance initiatives that merely reward doctors if they keep practice expenses down in ways that shortchange patient care.
“The real ugly part is that this can be camouflage for cost containment,” Nielsen said. “Doctors have to make sure they are a part of developing these [pay-for-performance] initiatives or it will be rammed down their throats.”
Grants awarded: In its first contributions, the Illinois Children’s Healthcare Foundation doled out nearly $6 million in grants to 32 organizations for programs to improve quality and access to medical-care services for children in the state.
Among the recipients are Children’s Memorial Hospital, which will spend a $545,382 grant on a year-round mental health program for 800 Chicago public school children; Horizon Hospice, which received a $200,000 grant to provide palliative care to 50 children; and the University of Chicago, which took home a $500,000 grant to create a statewide consulting and referral service connecting medical professionals through telemedicine technology.
The foundation was created as part of a $125 settlement paid two years ago by Health Care Service Corp., parent of Blue Cross and Blue Shield of Illinois, which was accused of holding on to charitable assets when it converted to a mutual insurance company in 1982.