Physician Pay Will Soon Depend on Outcomes

Cheryl Clark, for HealthLeaders Media , June 13, 2013

But patient outcomes are already a pay-for-performance measure for hospitals, which are blamed and penalized for performance on excessive readmissions. Starting Oct. 1, 2014, they'll be penalized for higher rates of 30-day mortality for three diseases/conditions, and for central line bloodstream infections, and for a composite of never events such as pressure ulcers and blood clots.

Doctors now will have their turn to share the responsibility and the financial risk for keeping patients healthy and out of the hospital.

Bagley and many other physician leaders I've spoken with don't dispute that measurement should move from being primarily process-based to primarily outcomes-based. Eventually. 

But whether doctors should be measured alone, or in group practices, and by how many measures remains in dispute.

Now, in sessions that are probably filled with acrimony and tension, professional societies and registries are trying to come up with outcome measures that fairly reflect their procedural services, and distinguish good performers from those who might be better off finding another line of work. 

"The American College of Cardiology has a good measurement strategy and a good registry of outcomes for a large population of their members. They have this stuff figured out," Bagley says. "But that's not the case for other specialties."

For example, he says, "Think about the ear, nose, and throat doctor. We have some measures around otitis externa and sinusitis. But that doesn't come close to the range of things they do every day."

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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.




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