Pay for performance is scheduled to begin this July. This proposed mechanism of quality improvement has been extensively editorialized in the medical and lay literature, and its effects have been studied. Rosenthal and colleagues studied cervical cancer screening, mammography, and hemoglobin A1c testing as measures of clinical quality with pay for performance using administrative reports of physician group quality from a large health plan for an intervention group (California physician groups) and a comparison group (Pacific Northwest physician groups).
1 P4P Study Findings
Improvements were 5.3% vs. 1.7% for cervical cancer, 1.9% vs. 0.2% for mammography, and 2.1% vs. 2.1% for hemoglobin A1c testing, comparing California and Pacific Northwest, respectively. The total amount awarded was $3.4 million, and the study found that — physician groups with good baseline performance improved the least but gained the largest share of the bonus payments.
The study finally concluded that “paying clinicians to reach a common, fixed performance target may produce little gain in quality for the money spent and will largely reward those with higher performance at baseline.”
Dermatology Measures
Pay for performance measures for dermatology will include the following:
- asking patients if they have a history of malignant melanoma or new/changing melanocytic lesions
- performing a full skin examination in patients with history of malignant melanoma
- encouraging patients with history of malignant melanoma to perform self skin exams.2
I believe that the above-outlined measures are simply good medical practice.
However, many physicians — dermatologists included — have voiced concerns regarding this program, specifically pertaining to a possible decrease in reimbursement.
Media Commentary
Perhaps what is even more interesting are the opinions found in the lay press regarding this issue. A New York Times article3 compared pay for performance to a “carrot” used instead of a “stick” in order to “change doctors’ behavior.”
This article contended that by giving doctors small amounts of money, doctors will have to report how often they provide “quality care, as defined by the government.”
This would be the opposite of what some believe Medicare does now in rewarding doctors “to treat complications caused by their own mistakes.”
The author does point out concerns of physicians and some lawmakers that these measure may lead to “cookbook medicine and could erode the professional autonomy of doctors.”3
Cost Issues
Some may believe that this program will not only improve patient care, but will also save money.
This last goal is of vital importance because in 2012, healthcare spending is projected to reach $3.1 trillion — which is 17.7% of the Gross Domestic Product.4 However, little evidence exists that this program will achieve either of these goals.
Litigation Fears and Costs
Furthermore, if lawmakers were serious about decreasing the cost of healthcare, perhaps the issue of tort reform should be addressed first.
According to the U.S. Department of Health and Human Services, 79% of physicians admit that fear of litigation caused them to order more tests, 74% to refer more patients to specialists than they otherwise would, and 50% to recommend what they consider to be not-medically necessary procedures to confirm diagnoses because of litigation fears.5
In addition, it is estimated that “each American household is taxed more than $1,200 to pay the costs associated with defending frivolous lawsuits, jackpot jury awards, and the costs associated with defensive medicine.”5 Perhaps it is the strength of influence of The American Association for Justice (formerly known as The Association of Trial Lawyers of America) that is the real reason why tort reform isn’t in the forefront of reform and pay for performance is.
Challenges
I am a proponent of any system that would improve the quality of care our patients receive. I also believe that the pay for performance measures currently outlined for our specialty are simply good medical practice. However, it appears that more challenges lay ahead of us and that the more pressing issues, such as tort reform, will once again be put on a back burner by our lawmakers. Why? We can only speculate.
Pay for performance is scheduled to begin this July. This proposed mechanism of quality improvement has been extensively editorialized in the medical and lay literature, and its effects have been studied. Rosenthal and colleagues studied cervical cancer screening, mammography, and hemoglobin A1c testing as measures of clinical quality with pay for performance using administrative reports of physician group quality from a large health plan for an intervention group (California physician groups) and a comparison group (Pacific Northwest physician groups).
1 P4P Study Findings
Improvements were 5.3% vs. 1.7% for cervical cancer, 1.9% vs. 0.2% for mammography, and 2.1% vs. 2.1% for hemoglobin A1c testing, comparing California and Pacific Northwest, respectively. The total amount awarded was $3.4 million, and the study found that — physician groups with good baseline performance improved the least but gained the largest share of the bonus payments.
The study finally concluded that “paying clinicians to reach a common, fixed performance target may produce little gain in quality for the money spent and will largely reward those with higher performance at baseline.”
Dermatology Measures
Pay for performance measures for dermatology will include the following:
- asking patients if they have a history of malignant melanoma or new/changing melanocytic lesions
- performing a full skin examination in patients with history of malignant melanoma
- encouraging patients with history of malignant melanoma to perform self skin exams.2
I believe that the above-outlined measures are simply good medical practice.
However, many physicians — dermatologists included — have voiced concerns regarding this program, specifically pertaining to a possible decrease in reimbursement.
Media Commentary
Perhaps what is even more interesting are the opinions found in the lay press regarding this issue. A New York Times article3 compared pay for performance to a “carrot” used instead of a “stick” in order to “change doctors’ behavior.”
This article contended that by giving doctors small amounts of money, doctors will have to report how often they provide “quality care, as defined by the government.”
This would be the opposite of what some believe Medicare does now in rewarding doctors “to treat complications caused by their own mistakes.”
The author does point out concerns of physicians and some lawmakers that these measure may lead to “cookbook medicine and could erode the professional autonomy of doctors.”3
Cost Issues
Some may believe that this program will not only improve patient care, but will also save money.
This last goal is of vital importance because in 2012, healthcare spending is projected to reach $3.1 trillion — which is 17.7% of the Gross Domestic Product.4 However, little evidence exists that this program will achieve either of these goals.
Litigation Fears and Costs
Furthermore, if lawmakers were serious about decreasing the cost of healthcare, perhaps the issue of tort reform should be addressed first.
According to the U.S. Department of Health and Human Services, 79% of physicians admit that fear of litigation caused them to order more tests, 74% to refer more patients to specialists than they otherwise would, and 50% to recommend what they consider to be not-medically necessary procedures to confirm diagnoses because of litigation fears.5
In addition, it is estimated that “each American household is taxed more than $1,200 to pay the costs associated with defending frivolous lawsuits, jackpot jury awards, and the costs associated with defensive medicine.”5 Perhaps it is the strength of influence of The American Association for Justice (formerly known as The Association of Trial Lawyers of America) that is the real reason why tort reform isn’t in the forefront of reform and pay for performance is.
Challenges
I am a proponent of any system that would improve the quality of care our patients receive. I also believe that the pay for performance measures currently outlined for our specialty are simply good medical practice. However, it appears that more challenges lay ahead of us and that the more pressing issues, such as tort reform, will once again be put on a back burner by our lawmakers. Why? We can only speculate.
Pay for performance is scheduled to begin this July. This proposed mechanism of quality improvement has been extensively editorialized in the medical and lay literature, and its effects have been studied. Rosenthal and colleagues studied cervical cancer screening, mammography, and hemoglobin A1c testing as measures of clinical quality with pay for performance using administrative reports of physician group quality from a large health plan for an intervention group (California physician groups) and a comparison group (Pacific Northwest physician groups).
1 P4P Study Findings
Improvements were 5.3% vs. 1.7% for cervical cancer, 1.9% vs. 0.2% for mammography, and 2.1% vs. 2.1% for hemoglobin A1c testing, comparing California and Pacific Northwest, respectively. The total amount awarded was $3.4 million, and the study found that — physician groups with good baseline performance improved the least but gained the largest share of the bonus payments.
The study finally concluded that “paying clinicians to reach a common, fixed performance target may produce little gain in quality for the money spent and will largely reward those with higher performance at baseline.”
Dermatology Measures
Pay for performance measures for dermatology will include the following:
- asking patients if they have a history of malignant melanoma or new/changing melanocytic lesions
- performing a full skin examination in patients with history of malignant melanoma
- encouraging patients with history of malignant melanoma to perform self skin exams.2
I believe that the above-outlined measures are simply good medical practice.
However, many physicians — dermatologists included — have voiced concerns regarding this program, specifically pertaining to a possible decrease in reimbursement.
Media Commentary
Perhaps what is even more interesting are the opinions found in the lay press regarding this issue. A New York Times article3 compared pay for performance to a “carrot” used instead of a “stick” in order to “change doctors’ behavior.”
This article contended that by giving doctors small amounts of money, doctors will have to report how often they provide “quality care, as defined by the government.”
This would be the opposite of what some believe Medicare does now in rewarding doctors “to treat complications caused by their own mistakes.”
The author does point out concerns of physicians and some lawmakers that these measure may lead to “cookbook medicine and could erode the professional autonomy of doctors.”3
Cost Issues
Some may believe that this program will not only improve patient care, but will also save money.
This last goal is of vital importance because in 2012, healthcare spending is projected to reach $3.1 trillion — which is 17.7% of the Gross Domestic Product.4 However, little evidence exists that this program will achieve either of these goals.
Litigation Fears and Costs
Furthermore, if lawmakers were serious about decreasing the cost of healthcare, perhaps the issue of tort reform should be addressed first.
According to the U.S. Department of Health and Human Services, 79% of physicians admit that fear of litigation caused them to order more tests, 74% to refer more patients to specialists than they otherwise would, and 50% to recommend what they consider to be not-medically necessary procedures to confirm diagnoses because of litigation fears.5
In addition, it is estimated that “each American household is taxed more than $1,200 to pay the costs associated with defending frivolous lawsuits, jackpot jury awards, and the costs associated with defensive medicine.”5 Perhaps it is the strength of influence of The American Association for Justice (formerly known as The Association of Trial Lawyers of America) that is the real reason why tort reform isn’t in the forefront of reform and pay for performance is.
Challenges
I am a proponent of any system that would improve the quality of care our patients receive. I also believe that the pay for performance measures currently outlined for our specialty are simply good medical practice. However, it appears that more challenges lay ahead of us and that the more pressing issues, such as tort reform, will once again be put on a back burner by our lawmakers. Why? We can only speculate.
