Wednesday, August 1, 2007

Profiling, Pay for Performance, and Protocols for Physicians

I just received a brochure “Summit on Provider Profiling & Pay for Performance: Proven Solutions to Engage Providers, Improve and Reward Quality and Optimize Financial Efficiency, “ a conference to be held Oct. 23-24 in Bally’s in Las Vegas.

Sponsors include Cigna, various Blue Cross Plans, Aetna, AmeriGroup Corp. The Regence Group, Humana, Inc, HIP Plan of New York, Harvard Pilgrim, Texas Medical Association, the Centers of Medicare and Medicae. Managed Care Week, The Executive Report in Managed Care, the Managed Care Information Center, and the Pay for Performance Reporter will report the event.

The cost for attending this day summit varies from $1295 to $2495, depending on if you want to attend the conference only or the conference and two workshops. The blurb promoting the event says “Learn from over 18 CMOs and National Medical Directors to achieve a genuine ROI!”

Here are some questions I put to doctors to see how they would react to this brochure?

What is your impression of such a conference?

•Is this a good thing or a bad thing”

•Will it help you practice better medicine and improve care for your patients?

•Do you believe such a conference, the latest emphasis of the managed care industry, will cut costs, reward good doctors, improve care, and result in better health outcomes?

•Do you think this conference will be a step forward in incentivizing doctors to practice better medicine?

• Do you think the conference will help health plans “reap robust financial and quality rewards without expanding healthcare expenditures?”

• Will P4P and physician profiling increase physician productivity, efficiency, and quality, or is it an added bureaucratic burden that will increase practice costs and lead to more hassles and overhead?

• Are profiling, pay for performance, and protocols tantamount to having third parties practice medicine – and subsidizing their judgment for the judgment of the physician?

• Are provider profiling, pay for performance, and clinical protocols an effort to justify the further existence of third party insurers?

From physicians, I expect I will get a mixed response, and I anticipate it will be mostly negative since profiling, pay for performance, and protocols threaten their autonomy and raise the specter of “Big Brother”overseeing their daily practices.

In the keynote presentation to the event, Allen Hinkle, MD, chief medical officer and senior vice president Health Value, Tufts Health Plan, will deliver an address “Capitlizing on Evidence-Based Medicine for Variation Management in P4P: Searching for Taguchi’s Tau.”

Here is the gist of what Hinkle will say:
GenichiTaguchi, a Japanese engineer born in 1924, recognized that pursuing an ideal target (τ Tau) requires understanding of why managing variation leads to superior quality. Integrating evidence-based medicine (EBM) into clinical-decision making reduces unexplained variation in health care services and defines the right target. A collaborative relationship between providers and health plans focusing on managing variation starts with accurate data and strong analytical skill. Finally, if provider-health plan incentives are aligned successfully, variation management can result in robust financial and quality rewards when linked to a P4P program without further expanding health care expenditures. Highlights of this keynote include:

•Identifying why excessive variation in health care services is a quality concern

•Understanding how efforts to manage variation must be a joint effort between physicians and health plans and designed with aligned incentives so that a true win-win exists

•Integrating EBM into clinical practice to achieve clinically appropriate variation management

•Linking a P4P approach that rewards achievement of the right cost and quality.


ObGynThoughts said...

I agree with the management of variation as a way to better performance. You could also call it "standardization".
Pay for performance is a thinly veiled attempt of the insurances (and that is why the insurances came up with this idea and that is why the insurances sponsored the congress) to find an excuse to pay less. It has become harder to pay less. So they had to come up with a new plan. And performance appeals to every good American. Who could say "no" to that?
As you will see - but only when it is too late - it should be called "Not Pay for Not Performance". In the end, the top performers (=lowest price providers with maximum compliance with HMO standards)will be paid the present normal rate. evrybody else will be paid less.
Have we learned nothing from the past? Do we have to fall for another trick?
Has everybody forgotten the incentive "If you work for just a little less, then we'll send you more patients?" They knew that the real point was in paying less, and soon everybody had all the HMOs and as a result everybody was paid less. How many times do we have to go through this nonsense to protest and not comply?

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