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Pay-for-Performance Participation Can Be Pricey for Docs

Cheryl Clark, for HealthLeaders Media, November 10, 2009

Pay for performance may be the rage, and the future of physician reimbursement—but it doesn't come cheap.

Responding to all those requests for data, proper planning, training, coding, data entry, and modification of electronic systems cost physician practices between $1,000 to $11,100 in implementation costs per doctor, and from about $100 to $4,300 per year per clinician after the program was launched, according to a survey of eight physician practices participating in four quality reporting programs in North Carolina.

"One thing is clear," wrote Jacqueline R. Halladay, MD, the study's author and a UNC researcher. "Participation in quality-reporting programs requires resources that have measurable costs. The costs appear high, especially when compared with the modest reimbursement offered by many programs."

The report added, "To date, the question of whether participation in quality-reporting is worth the time, effort and expense is largely unresolved."

The study was published Monday in the Annals of Family Medicine.

The UNC report found substantial variation in the resources used by four reporting programs. There was a wide variation in the "amount of work shouldered by the quality improvement program staff, the intensity of a program's quality focus, and the time required for quality improvement work beyond data collecting and reporting."

Small practices appeared especially hard hit by the program participation costs, she said.

The researchers examined costs of four incentive programs: Medicare's Physician Quality Reporting Initiative (PQRI); Improving Performance in Practice in North Carolina and Colorado (IPIP); Bridges To Excellence, (BTE), implemented by Blue Cross/Blue Shield of North Carolina; and Community Care of North Carolina (CCNC).

Practices selected included four for-profit practices, three non-profit practices, and one teaching practice and represented variation in size, ownership, specialty, location, and medical record formats.

The major costs included planning meetings, clinician time required to gather and code data, information technology system modification, and staff time to verify the accuracy of the clinicians' coding.

"Despite the enthusiasm for quality improvement, reporting activities have occurred with relatively little regard to the challenges primary care practices face in collecting and reporting requested data," according to the report.


Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.
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