Medicare Prepares to “Pay for Performance”

The Hospitalist. 2007 March;2007(03):

March 1, 2007 | The Hospitalist

Bonuses for voluntary reporting would be in a lump sum and won’t be paid until the first quarter of 2008. The method of payment may be subject to certain limits—and it may not offset the physicians’ administrative costs for reporting. Hospital medicine programs will have to consider whether the costs of reporting are worth the bonus.

SHM Involvement

SHM’s Public Policy Committee (PPC) and its Performance and Standards Task Force (PSTF) have been actively involved in getting measures included on the PRVP list that are applicable to hospitalists.

“SHM is a member of the AMA’s Physician Consortium for Performance Improvement (PCPI) and has representatives on work groups that have developed performance measures and will be revising and maintaining measures over time,” says Dr. Torcson. “We hope to eventually include measures that are specific to hospitalized patients.”

Personal Health Records for 2.5 Million

On December 6, 2006, a group of large employers, including Wal-Mart, BP America, Intel, Pitney Bowes, and Applied Materials, unveiled Dossia, a system the employers say will enable individuals to control their own medical data from multiple sources and to create and access their own personal, private, and portable electronic health records. The Web-based system will roll out in 2007 and will include medical records for a total of 2.5 million employees.

Dossia will allow the individual to develop a personal health record either by entering the data himself or by enabling the system to search and securely aggregate his health data from various sources. Once Dossia is complete, it will be able to pull information from all available electronic sources within the healthcare system.

Source: Major U.S. employers join to provide lifelong personal health records for employees [press release]. Dossia; December 6, 2006.

CMS Seeks Input on Value-Based Purchasing

CMS has requested input from hospitals on a new plan for Medicare hospital value-based purchasing, mandated under the Deficit Reduction Act. To date, verbal and written comments have been solicited regarding quality measures, data infrastructure and validation, incentives, and public reporting. For the latest information on the plan, visit www.cms.hhs.gov/center/hospital.asp.

In addition to the PCPI, SHM is represented and has influence in the National Quality Forum and the Ambulatory Care Quality Alliance.

“SHM leadership—CEO Larry Wellikson, Eric Siegal, Public Policy chair, and Lakshmi Halasyamani, chair of the Hospital Quality and Patient Safety (HQPS) Committee—have been proactive in positioning SHM to be very involved in the national quality improvement agenda,” says Dr. Torcson. “It’s really a work in progress, but SHM is part of the work groups that are driving this process.”

The Effect on Hospitalists

As they can with the original PVRP, hospitalists can find a few applicable performance measures to report on, so they are eligible to participate—and SHM encourages them to do so.

“The amount of money will be small and the number of [applicable] measures will be limited and not truly representative of a hospitalist’s practice,” says Dr. Torcson, “but performance reporting should be something that every physician, including hospitalists, has as a skill set as their practice moves into the future.”

Moving Ahead

Details on the new program still need to be clarified by CMS in the first half of 2007. Regardless of the details still to be determined for this first major foray into Medicare pay for performance, one thing is clear: CMS is dedicated to the idea of tying financial reward to quality care. And they aren’t the only ones.

“Medicare is not as far along as private insurers,” says Dr. Torcson. “Commercial insurers are much more aggressive about pursuing physician-level performance and efficiency—I think we’ll see more impactful pay-for-performance plans from them first. However, the CMS model will affect 70 million patients, and commercial insurers have tended to use the CMS model for physician reimbursement.”