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| Archive : Fall
2006 |
FOR A FIVE-STAR RATING AND MAYBE A SMALL BONUS, DOCS MUST:
Track dozens of performance measures // Sift through hundreds of patient records // Swallow thousands of dollars in overhead costs—when all they want is to deliver better care.
The Quest for Quality
 By Linda Keslar |
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M ost physicians like to think they’re taking good care of their patients while also running efficient businesses. Louisville family practitioner A. O’tayo Lalude is no exception. Two years ago, when Lalude heard about a project designed to develop “best practices” in diabetes care, he volunteered. The program, sponsored by Bridges to Excellence (BTE), a coalition of large national employers, health plans and care providers, also promised bonuses to doctors who met certain standards of care.
Lalude is one of a growing number of physicians participating in such “pay for performance” programs. More than 100 so-called P4P initiatives are under way, and many more are in the works. Sponsors include Fortune 100 corporations, government agencies and coalitions in the mold of BTE. The pilot programs are paying financial incentives to physicians who encourage prevention and patient follow-up visits—moves some believe could save billions of dollars and lead to fundamental changes in the ways physicians interact with patients.
The BTE-sponsored quality measures, for example, require Lalude to monitor how well diabetics in his practice manage their blood sugar and blood pressure and to schedule tests such as eye and foot examinations (diabetes can lead to blindness and amputations). But keeping close tabs on patient behavior turned out to be no small hurdle because, like many solo practitioners, Lalude lacks a sophisticated computer system. His solution was to sift through his color-coded files to create flowcharts. “It was time-consuming, but it also allowed me to see my deficiencies,” Lalude says.
So far the impact on Lalude’s bottom line has been negligible—an annual bonus of $1,400 (minus a $450 participation fee he must pay every three years). But with nearly 90% of his diabetic patients now getting proper testing and follow-up, Lalude is confident that he’s delivering better care. He has also gained on the public relations front, earning a four-star rating (of a possible four, though some programs award five) in an Internet listing sponsored by the American Diabetes Association and the National Committee for Quality Assurance, which rate managed-care plans. And he has received mention in employee publications for General Electric and Ford Motor Co., members of the BTE coalition. “It has been a win-win for me,” says Lalude. “I tell colleagues P4P is an inevitability.”
A national poll conducted by the American College of Physician Executives late last year indicated that nearly three-quarters of doctors are already involved in P4P programs or expect to become involved. Yet there’s also considerable resistance: Another study, by the Center for Studying Health System Change (HSC) in Washington, D.C., reported that physician attitudes about P4P in 12 health-care markets range from skeptical to hostile.
Witness the slow response to the Physician Voluntary Reporting Program, sponsored by the Centers for Medicare & Medicaid Services (CMS). Launched this past spring, the program includes a “starter set” of 16 quality measures—from documenting whether a heart attack patient is given aspirin upon arriving at the treatment site to checking an elderly patient’s history of falls—that are intended to introduce physicians to simple goals while more sophisticated measurements are being developed. Around 2% of physicians who routinely bill Medicare have signed on. And while Nancy Wilson, joint senior adviser to CMS and the Agency for Healthcare Research and Quality in Rockville, Md., expects participation to pick up, she understands why most doctors are holding back. “It isn’t clear that we’ve been able to accurately portray physician performance from a quality or efficiency standpoint,” she says.
Many doctors would put it less delicately. After decades of calls by bureaucrats to standardize medical methods—what critics have termed cookbook medicine—physicians are leery of these latest efforts, which often seem to have more to do with containing costs than with ensuring quality. Many, for example, think the tracking process adds costs without clear benefits to doctors or their patients. |
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Photo by Sarah A. Friedman
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