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    Monday, August 06, 2007

    Pay for What? The "pay for performance" program that Medicare is rolling out is supposed to reward physicians for quality care, right? Think again:

    Ten large physician practices participating in one of the first Medicare pay-for-performance projects have proven that such programs lead to better performance, according to government officials. But only two practices were able to reduce costs enough to receive any additional pay.

    ... Two of the participants, Forsyth Medical Group in Winston-Salem, N.C., and St. John's Health System in Springfield, Mo., were able to make the grade on all diabetes measures.

    They made the grade, but they didn't get the reward:

    But for eight of the large practices, the amount of money they saved Medicare was not enough for them to share in the reward. Only University of Michigan Faculty Group Practice in Ann Arbor and Marshfield (Wis.) Clinic were able to obtain bonuses.

    It's really about the money:

    In the first year, Marshfield saved the Medicare trust fund just more than $6 million, and the facility is set to receive roughly $4.5 million of that. University of Michigan Faculty Group Practice saved Medicare about $3.5 million and is in line for a roughly $2.8 million payout.

    If it were really about quality, the Forsyth Group and St. John's Health System would be the ones getting the bonus, wouldn't they?

    posted by Sydney on 8/06/2007 08:13:00 PM 2 comments


    I don't quite get your complaint. Quality care should save money in the long run but if it was known ahead how much had to be saved then those that didn't might have provided quality care but didn't provide the combination; quality care and money save.
    Mary, mother of dermatologist Mike

    By Blogger Antique Sailor, at 8:26 PM  

    Antique Sailor,

    It doesn't necessarily follow that better quality= money saved, especially in medicine. Many of the interventions we do to improve quality are quite expensive. Colonoscopies to screen for colon cancer, for example, cost $2,000 each. Colonoscopies save lives, but it's not clear that they don't save money.

    Also, chronic diseases are progressive diseases. You can do everything right with a diabetic, and the diabetic himself can do everything right, but there comes a day when the day disease progresses - the control becomes harder to maintain, more drugs have to be added, complications develop, etc. That day is delayed by quality care, but it isn't forever postponed.

    By Blogger sydney, at 10:57 PM  

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