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Physician Pay Will Soon Depend on Outcomes

Cheryl Clark, for HealthLeaders Media, June 13, 2013

"We're moving toward a point at which there's an expectation that a certain level of quality will be delivered, and that date is 2015," says Bruce Bagley, MD, interim president and CEO of TransforMED, a subsidiary of the American Academy of Family Physicians, which supports physicians in their development of medical homes.  "And they'll be using 2013 calendar year (performance) data… with the level of payment moving up or down, depending on the data."

Look for scoring of group practice data to be posted on Physician Compare as well, starting next year.

No longer will doctors have to simply check a box that they prescribed the drug they thought the patient needed or any of CMS's recommended process measures on the expanding federal list.

The time is coming soon when they'll have to show their patients improved, or didn't get worse, at least by some defined measures, if they want to receive their full Medicare reimbursement.

For example, instead of being scored on the basis of whether they ordered periodic hemoglobin A1c testing for all their patients with diabetes, doctors' quality of care might be gauged on what a percentage of patients with unfavorable A1c levels met a certain A1c threshold after treatment.

That's tough; we all know. Doctors can tell patients to lose weight or take their medication or exercise, but the advice often falls on deaf ears.

The PQRS program began in 2007 as a voluntary pay-for-reporting initiative, in which doctors received a 2% bonus for reporting on fewer than 70 process measures. Few participated at first.

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1 comments on "Physician Pay Will Soon Depend on Outcomes"


Arun K. Potdar (6/14/2013 at 6:35 PM)
Very informative article. However I feel one important aspect of patients' apathy to follow physicians' orders and instructions need to be address in more details. The the presence of Insurers is also a contributory factor. patients often have to choose between affordability of care and do what is prescribed. This is true for young adults and elderly who are not duel qualified for being slightly over the Medicaid threshold or having small assets valued beyond allowable Dollars. If one remains in traditional Medicare plan he or she has to have a supplemental insurance plan which AARP's brochure shows about $260 per month. Anyone receiving per month, $1400 or more in So. Security can't afford so much and if one goes into Managed Care plan (Medicare Advantage) then the premiums are low but the cost of diagnostic procedures is shifted onto patient at the rate of 51 or more percent. I personally know individual who did not go to get Diagnostic Radiology to check out a persistent but not very painful abdominal area because Aetna HMO 's Evidence of Coverage booklet indicated diagnostic radiology other than X-ray has a co-pay equal to percentage of cost. When he called the member services he was told that the $$ will be determined by the type of test ordered and MRI or CT scan is a specialized radiology and it would cost about $225 in co-pay. I managed radiology and I know Medicare approved charges are going to be around $450 or more so Aetna is making full %600 to $700. The patient has not gone to take that test and three four weeks are gone bye. What a Physician to do with this? Insurance companies are the primary cause of waste, greed and indifference to quality of care. Under the protection of CMS, Advantage Plans are protected from the State Insurance Regulations then what a patient or physician going to do if the outcome is not what the Quality Indexes indicate and he lands up in the Hospital or worst Cancer Treatment Center? I am studying all facets of initiatives under ACA but I do not believe this will work until the basic hindrances like access to specialists and financial deterrent to obtaining care are not resolved. I hope you will discuss this in your next article. Thanks for a well written and informative paper.