The first major national summit on pay for performance (P4P) is taking place in Los Angeles. The biggest P4P program, in California, is now coming up to its second annual payout and is showing some interesting results. At this stage it only is really working with the HMO population in the larger medical groups and IPAs. Most of the rewards went to the top performers, rather than to those improving the most.
GE's Francois De Brantes described the Bridges to Excellence program, which is working with different types of physician practices in several cities. Andrew Foster from the Department of Health in the UK, described the world's largest P4P program, noting that it happened in conjunction with a large deliberate increase in health spending--not something that's in the works in the U.S. As AHRQ's Carolyn Clancy said, the P4P train has left the station, but we're not sure where it's going.
The biggest problem for attaining quality remains perverse payment streams. Brent James from Intermountain described how after improving care processes and reducing costs in their system, they actually lost money because patients were moved from more profitable DRGs to less profitable ones.
- see this post on the Healthcare Blog
PLUS: Bridges to Excellence announced a new P4P initiative with the American Board of Internal Medicine that would enroll about 180,000 physicians in a new quality program. Article