The Medicare Physician Quality Reporting Initiative PQRI discussed in today’s cover story is one example of a pay-for-performance program (P4P). The P4P idea has been around a few decades, beginning with the growth of managed care and the advent of “preferred providers.”
Increasingly in the future, payers and governmental agencies will institute reporting requirements to qualify for incentives or dodge penalties.
Therefore, medical offices considering a move to electronic health record (EHR) systems should be certain their vendors can provide analytics tools that allow systems to not only capture data for P4P reporting, but also analyze and report on that data.
The P4P programs represent an effort by insurers and employers to see a return on investment by essentially paying for quality while reducing or at least controlling costs.
Today, a majority of managed care companies have P4P plans that rate physicians based on measures devised to reward good health outcomes – typically for diseases like asthma, diabetes, cardiovascular disease and for preventive measures.
For example, physicians may receive 2 or 3 percent above the normal pay rate for helping to maintain good glycemic control in a diabetic patient.
In November, Anthem announced it had doled out $3.1 million to Indianapolis-area physicians in its quality measurement system. The insurer said the average payout to the 831 participating physicians was $3,730 and interest in the program had “dramatically increased.”
Sounds good but netting that bonus requires extra work for physicians and medical staffs. It involves capturing data and measuring how you’re doing, extremely difficult in a paper-based practice. While EHRs make reporting somewhat easier, it can still be a demanding process.