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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 [page 5]
 By Linda Keslar |
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Stuart Weinstein, an Iowa City pediatric orthopedic surgeon and former president of the 28,000-member American Academy of Orthopaedic Surgeons, thinks that the timetable endorsed by the AMA and congressional leaders is unrealistic. “Performance measures need to be developed by specialty societies, then tested and validated to confirm they really affect patient care in a positive way,” he says. “We don’t think these measures can be simply mandated.”
What’s more, says Weinstein, developing a good measure can be difficult, in part because there’s not always consensus. Medicare’s Physician Voluntary Reporting Program, for example, includes measures for preventing blood clots in surgical patients. But, says Weinstein: “Not everyone agrees what’s best.”
Many physician organizations, while apparently accepting the inevitability of complying with quality measures, nevertheless have been hoping for a relatively slow, deliberate transition involving government-sponsored pilot programs to see what works and what doesn’t. In August 2005, a few months before the AMA deal, the American College of Physicians (ACP) and 70 other national medical societies sent Congress a plan for a five-year phase-in of P4P for Medicare.
Dana Safran, director of the Health Institute at Tufts–New England Medical Center in Boston, who has spent the past 15 years researching how to measure the quality of patient experiences, also advises caution as the major players continue to experiment. “P4P runs the risk of pushing the measures beyond what they can do accurately, making unjustified inferences about physician or hospital performance,” Safran says. “You have to use these tools fairly and with precision, because of the risks involved in getting it wrong.”
There’s also the chance, says the Urban Institute’s Berenson, that the impact of P4P could be much less profound than many expect. Most patients of doctors in the pilot programs, Berenson says, are unlikely to detect much of a difference beyond, perhaps, getting more frequent calls to schedule follow-up appointments. “If P4P is done right, there might be small improvements in care, but it’s not going to solve all our problems—particularly not the spiraling costs,” he says.
Yet for now, as baby boomers move into retirement and put the health-care system to a monumental test, all bets are on P4P. Says CMS’s Wilson: “The momentum is unprecedented in terms of people talking to each other, collaborating and building consensus to make this work.”
 Dossier
1.“Early Experience With Pay-for-Performance: From Concept to Practice,” by Meredith Rosenthal et al., Journal of the American Medical Association, Oct. 12, 2005. One of the first published studies on the subject, focusing on lessons to be learned.
2.Performance Measurement: Accelerating Improvement, by the Institute of Medicine, National Academies Press, 2006. Landmark analysis that recommends standardizing performance measures and other strategies for adopting pay for performance nationally.
3.“Large Employers’ New Strategies in Health Care,” by Robert Galvin and Arnold Milstein, New England Journal of Medicine, Sept. 19, 2002. Informative article that explains programs under way at companies with 10,000 or more employees.
4.“The Unintended Consequences of Publicly Reporting Quality Information,” by Rachel M. Werner and David A. Asch, Journal of the American Medical Association, March 9, 2005. A thorough analysis of the potential limitations of health-care report cards for improving quality of medical care. |
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Photo by Sarah A. Friedman |
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