Study: P4P may have little impact on quality

Anne Zieger — Mon, 28 Jul 2008 09:05:11 -0400

Of late, health plans and employers have been rolling out pay-for-performance programs aggressively on the assumption that such programs offer a helpful method for improving healthcare quality. In fact, more than 150 programs built around rewarding evidence-based care exist, according to research by American Medical News. However, according to one piece of research, some of these efforts might be wasted. That, at least, is the conclusion drawn by a new analysis of quality incentives published in Health Affairs.

The study, which compared 81 Massachusetts physician groups in incentive programs with 73 that were not, found that while overall performance on preventive measures like breast cancer screening and well-child visits improved 73 percent, it was impossible to distinguish one group of physicians from the other statistically. In other words, all physicians' quality improved, whether or not they were jockeying for a bonus.

These results don't necessarily suggest that all P4P programs don't work, the study's authors stressed. The impact of P4P initiatives can vary dramatically depending on how the program is implemented, they noted. Also, American P4P programs tend to offer rewards in the range of 5 percent to 9 percent of payments, which may not be enough to motivate doctors. (In contrast, British doctors can more than double their income by meeting quality targets.)

To learn more about this study:
- read this AMNews piece

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CMS wants to cut skilled-nursing spending

Fri, 02 May 2008 06:59:56 -0400

CMS says it is proposing to cut about $770 million in overall payments to skilled-nursing facilities in fiscal 2009, though it also plans to help the industry with an inflationary update to absorb some of the difference. The change is one of several planned by the agency to address what it sees as industry upcoding.

All told, CMS wants to cut 3.3 percent in overall payments, but the update will amount to about 3.1 percent. The remaining gap is about $60 million net loss between this year and next. Under the new payment rule, CMS would change case-mix weighting to better align its reimbursement structure with the "right" procedures. It may also toss pay-for-performance initiatives and other quality incentives into the mix.

To learn more about the CMS proposal:
- read this Modern Healthcare piece (reg. req.)

Related Articles:
CMS tightening quality-reporting measures
MD groups struggle with Medicare incentive goals
AMA addresses Medicare reimbursement cuts