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Issue Date: August 2007
Federal P4P Results Raise Questions
When evaluating pay for performance (P4P) programs, it’s important to consider the source. It’s not unusual for proponents of P4P to promote these programs by saying they produce remarkable results. Opponents of P4P, meanwhile, readily point out the flaws.
Last month, the federal Centers for Medicare & Medicaid Services (CMS) reported that its demonstration project involving P4P for 10 large physician groups was a success. And, by many measures, this statement is true. But, only two of the 10 groups received any financial performance incentive. All participating physician groups improved the clinical management of diabetes patients in the first year of the three-year Medicare Physician Group Practice Demonstration, CMS said.
Direct Contracts Offer an Alternative
Some physicians who are tired of low reimbursements and stringent managed care contracting terms have found that direct contracts are a viable way to increase patient volume. Direct contracting appeals to both physicians and employers because the agreements protect the interests of both parties, reducing health care costs while offering better reimbursement for physicians.
“Physicians may view direct contracting as an opportunity to retain or increase market share,” says Jeffrey B. Milburn, vice president of managed care at Colorado Springs Health Partners, an 80-physician multispecialty group practice with 11 locations in the Pike’s Peak region. “In other cases, they like the idea of eliminating the middleman from the managed care equation.” Colorado Springs Health Partners has negotiated two direct contracts covering general health services. Other direct contracts have covered workers’ compensation services only.
Automated Dispensing Enhances Safety
A rising number of physician groups are purchasing automated medication dispensing systems to enhance patient safety and practice efficiency. Many physician specialists can use automated dispensing systems, and they are particularly useful in specialties such as oncology and rheumatology in which practices provide medication therapy to patients on-site.
“Since oncology uses more pharmaceuticals than any other branch of medicine, a medication delivery system that ensures safety, minimizes waste, and reduces the standard drug inventory is important for any oncology practice,” says Bruce Feinberg, MD, president and CEO of Georgia Cancer Specialists, in Atlanta. In 1998, the group adopted the OmniRx system from Omnicell, Inc., in Mountain View, Calif.
How to Recruit and Retain Specialists
Recruiting physicians is a major undertaking for any medical practice, whether the practice is looking to grow through the addition of an associate, or seeking to fill an open position. With the nation’s diminishing pool of physicians, recruiting takes longer than it did in years past and often requires intensive search activities. Even with professional assistance, the process can take a significant amount of time away from clinical and other administrative responsibilities.
Since there’s a heavy investment of time and resources, it’s little wonder that practices also hope to retain the individuals currently on staff. And because turnover is costly, it’s important that practices retain qualified and productive physicians.
Use of IT Improves Patient Care
Physician groups in California that use information technology (IT) to support patient care get better scores on clinical quality measures than those groups that do not use IT, according to the Integrated Healthcare Association. A nonprofit collaborative of health plans and physician groups, IHA found that physician groups participating in its 4-year-old pay for performance (P4P) program improved in all three areas of performance measurement: information technology, clinical quality, and patient experience. IHA released P4P program results for 2006 last month.
Practice Uses Patient-Centered Approach
Dennis H. Birenbaum, MD, is president and CEO of the Texas Hematology/Oncology Center, P.A., in Dallas, and medical director of the Patient’s Comprehensive Cancer Center (PCCC) in Carrollton, Texas, and the McKinney Regional Cancer Center (MRCC) in McKinney, Texas. Even though Birenbaum is an oncologist, the lessons he offers apply to physicians of all specialties. He spoke with contributing editor Richard L. Reece, MD, about patient-centered care.
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