Effect of Pay for Performance on PC Uncertain
But setting up incentive programs is not a small task, Mr. deBrantes said. Because incentives need to be large enough to encourage physicians to make significant practice changes, it's hard for any one employer or health plan to set up rewards programs.
It's also a major undertaking for physicians and their staffs, especially given the cost and complexity of electronic health record systems. (See box.) The transition from a paper-based practice to something more systematic takes about a year and a half with outside help, which, for small practices, is nearly impossible to make the transition without, Mr. deBrantes said.
Some of the measures may not be relevant to older Medicare patients, said Dr. Barry M. Straube (right). Calvin Pierce/Elsevier Global Medical News
Invest Wisely in Information Technology
One of the barriers to systematically measuring quality for physicians, especially those in small practices, is the cost of electronic health records and other technology.
“Don't waste a lot of time and money on high-tech solutions,” advised Dr. Kevin B. Weiss, professor of medicine at Northwestern University, Chicago, and chair of the ACP's performance measurement subcommittee.
Dr. Weiss, who said he considers himself a believer in health information technology, cautioned that many of the first- and second-generation EHRs were not designed for population-based medicine, which is essential for participation in pay-for-performance programs. Instead, the systems were built to mimic paper records and to work with individual patients.
Consider investing in EHRs that have population-based care functionality, or look into cheaper alternatives, he said. A lower-cost option is to use patient registries, he said. Patient registry software allows physicians to track their management of patients with chronic health conditions and to report on process and outcomes data that may be required by pay-for-performance programs.
One way to get ready for the pay-for-performance movement that does not involve any technology is to get in the habit of having weekly discussions with staff on quality issues, Dr. Weiss said. Physicians can also consider investing in team-oriented continuing medical education courses, he said.
