Sunday, December 10, 2006

Doctor Medicare Payments Preserved - With a Catch

At the last minute, like the Grinch Who Stole Christmas and later repented, Congress's proposed 5% Medicare payment cuts were spared, in part due to a strong push by physician advocacy groups. To be reported in tomorrow's Wall Street Journal (subscription):
Congress agreed to erase a scheduled reduction in payments to physicians, but it made a 1.5% bonus payment available only to physicians who report to Medicare how they perform on certain specified barometers of health-care quality. Initially, the payments will be based on whether the physician reports the data, but the system lays the groundwork for higher payments to better-performing physicians.

Among the information Medicare officials will collect: whether doctors provide aspirin and beta blockers to patients having heart attacks, and whether elderly patients are screened for their risk of falls. These practices are considered indicators of good patient care.

Hospitals, too, will have greater responsibility for reporting quality-of-care data. While most hospitals already have been doing quality reporting on inpatient care, the new legislation requires them to do so for outpatient services to receive the full payment scheduled under law for those services. Congress added an additional wrinkle to the program in the latest legislation, requiring the Department of Health and Human Services to consider ways that the hospital data could be made available to the public.
The implication of this bribery for reporting is significant, since it establishes a measly 1.5% premium on "Pay for Performance" - hardly a robust incentive. For instance, for a 20-minute outpatient follow-up visit that averages a $54 dollar Medicare reimbursement, Medicare is willing to pay an additional $0.81 for us to submit data about the drugs we give the patient. Since the payment isn't enough to offset the cost in man-hours to supply the data, will the data be complete or accurate?

And I hope they realize that not ALL patients with heart disease can take aspirin (due to allergies) or beta blockers (like patients with severe lung disease) after a heart attack. Will we be paid to "perform" when we fail to treat patients with these drugs in such circumstances?



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