For those of my readers who work in the medical field, perhaps the title of this post caused a slight shudder or tingling in the spine. Understandable, indeed, as we have become accustomed to health insurers devising ways to reduce payments under the guise of improved quality of care. But, as a provider interested in improving my performance and having “Quality” be a marketable part of my services, I can see potential value in the concept.
For those who have never heard of Pay 4 Performance, an quick overview is indicated:
Insurance companies, Medicare included, are developing systems of payment for medical services based on performance, or quality. For example, a Physical Therapist that reports the risk of falls for each patient would be eligible for improved reimbursement. A physician who screens for cervical cancer would benefit likewise.
A good overview is available via this article, last week in The LA Times. It talks about a state-wide pilot program in California. California is the state where managed care and HMO’s came from too.
While improving healthcare quality is a vitally important part of reform, healthcare providers are nervous that these initiatives will become mandated before the details are worked out.
- Currently, there is no agreed upon measures of what “Quality” practice consists of.
- Physical Therapists worry about measures having anything to do with PT at all, instead just being a poorly translated medical-based measure.
- How will the system compensate for those times when quality measures don’t make sense i.e. measuring for fall risk in a bed-bound or wheelchair bound patient.
- The list of concerns goes on.
In short, this change is coming, but everyone in concerned that it might just be more hoops to jump through to get paid, and that healthcare quality will not improve because of it. Careful planning is needed if quality is to improve. Either way, the insurance companies are gaining a tool to withhold more payments, and presumably, increase their bottom line. Personally, I hope it works out…maybe we could weed some of the detractors of quality out of our profession.
Here are some links:
Health Provider Report Card
Board of Directors of IHA, a leading institution behind this measure (note insurance bias of board)
Labels: health policy, physical therapy, Science Literacy