Pay-for-performance programs have been touted by some as a way to improve the overall quality of care provided to patients, while being criticized by others who fear unintended consequences in attempting to change physician behavior. The Medicare Payment Advisory Commission has recommended that pay-for-performance be incorporated into Medicare reimbursement policy in a number of areas. Recent laws, including the Medicare Modernization Act, have mandated pay-for-performance demonstration projects, including one for chronically ill Medicare patients.
Private payers are also experimenting with pay-for-performance. For example, the Integrated Healthcare Association in California, a collaborative effort by seven health plans, has developed pay-for-performance measurement tools. Several large employers have banded together to create Bridges to Excellence, which has devised financial incentives for physicians to improve diabetes and cardiac care management.
Can pay-for-performance both improve quality and constrain cost increases? What kind of performance is being measured and incentivized? How is data collected and audited? What special challenges arise when applying pay-for-performance to paying physicians?
To help address these and related questions, the Alliance for Health Reform and The Robert Wood Johnson Foundation sponsored a July 15 luncheon briefing. Speakers were: Margaret O’Kane, National Committee for Quality Assurance; Jeffrey Hanson of Verizon, president of Bridges to Excellence; Ronald Bangasser, Integrated Healthcare Association; and Terris King, Centers for Medicare and Medicaid Services. David Colby of the The Robert Wood Johnson Foundation and Ed Howard of the Alliance co-moderated.
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