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Physician Pay Will Soon Depend on Outcomes

Cheryl Clark, for HealthLeaders Media, June 13, 2013

"There was a lot of emphasis at first on process measures because they were easier to do, and physicians felt less threatened by that," Bagley says.

"But I think as time has gone on, everyone realizes the process measures, by and large, are most useful at a local level for quality improvement. If we're going to have a major effort to collect, aggregate, analyze and publish measures on a national basis, then it should be around a relatively few patient-oriented outcome measures," he says.

But if CMS starts measuring physician quality based on "what percentage of your patients have a hemoglobin A1c below 7, doctors start to get a little twitch because there's a lot that goes into that, including patients taking their medications, doing exercise, losing weight, and some of these things that are not perceived to be in the control of the physician," Bagley explains.

"Now, instead of just telling patients, 'Just try harder,' it helps to use known techniques to engage patients in their own self care, motivational interviewing, shared goal setting, contact between visits— all those things help patients get better results in the outcome measure," he says.

Payment will no longer be linked exclusively to care provided during an office visit.

I'm wildly speculating here, but imagine how far this might go for, say the doctor with lots of diabetes patients. Down the line, it might mean blood pressure control, a measure of expected-to-actual revascularizations, or even in the very extreme, how many patients with the disease were so poorly managed that they had to undergo an amputation. Or died.

That, of course would be drastic.  And no one I've spoken in recent days suspects it will come to that anytime soon.

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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.