These days, it's pretty clear that both CMS and private health insurers are committed to pay-for-performance schemes, but it seems that there's a fairly large gap between concept and reality, at least for medical groups. This is one of the key themes I expect to hear bandied about when I attend the upcoming annual conference for the Medical Group Management Association.
The MGMA's annual conference, which takes place this year on October 19-22 in San Diego, usually includes a healthy dose of standard practice management issues, the bread-and-butter stuff physicians need to handle basic operational issues. But this year it includes a full pay-for-performance seminar, as well, and I'm sure the talk in the hallways will be a running P4P seminar all on its own.
Why? Truth be told, I think the whole pay-for-performance movement is reaching a point of impasse. Most private health insurers peg their rates to what Medicare does, and medical groups are screaming that Medicare isn't paying enough in incentives to cover the costs of participating in its P4P programs. Medicare, meanwhile, apparently has no plans to increase what it pays in incentive bonuses, though it does plan to expand its slate P4P plays. We have a situation here in which payers and physicians may be getting further apart as the concept matures, not better aligned.
That being said, I'm fairly confident the market will work things out somehow, either with physicians finding a way to make money with existing incentives, or getting more income from quality efforts elsewhere (from hospital or employer partners perhaps). And health plans will probably find a way to pay physicians, which does more to account for their overhead.
In the meantime, if you're hoping to involve physicians in your pay-for-performance program, or want their support in accomplishing your facility's P4P goals, bear in mind that while they definitely support improved quality, they're feeling a little pinched right now. So be gentle. - Anne