Skip to comments.Empire debuts pay for performance for docs
Posted on 02/18/2011 6:58:17 AM PST by JustSurrounded
The biggest insurer in New York is debuting a pay for performance program to reward doctors who comply with certain best practices, but wont penalize those who fall short.
Empire BlueCross BlueShield plans to use claim data to better monitor whether physicians are complying with widely accepted medical best practices. Doctors who score well will receive better reimbursements.
The measurements are taking place, said Dr. Scott Breidbart, chief medical officer for Empire, which serves about 5 million members. We are rolling out this year in New York.
Other BlueCross BlueShield plans already have debuted similar programs, including Anthem, in Connecticut.
Breidbart said Empire wants to use the method and the money not only to reward best practices, but to encourage doctors to adopt them.
Other doctors will not be penalized, he said. We want all doctors to earn the top reward. The better the care our members get, the better off we all are.
The program, available for all commercial plans, includes an additional 3 percent to 5 percent above the standard fee schedule for visit codes as of August.
The doctors have not yet seen the enhanced fee issue, but nobody ever complains about getting more money, he said. The idea is to get doctors to the extent possible to pay more attention to doing things we consider important and give them the money to have that ability to spend more time.
Doctors, Breidbart said, would be rewarded for a good overall score on benchmarks such as making sure patients are immunized and giving diabetes patients a hemoglobin tests to measure blood sugar.
Standards of excellence factored into scores also include use of electronic health records, statins for patients with coronary artery disease, beta blockers for patients after a heart attack and avoiding unnecessary antibiotics for adults with bronchitis and children with an upper respiratory infection.
Doctors scores also would be boosted by certifications form the National Committee for Quality Assurance.
Practicing doctors are our partners, he added. We have to work with them to improve health care.
Breidbart said due to legal issues regulating reimbursement, Empire wont implement the program with government plans, but for our commercial programs, we enhance the fee schedule based on the result.
He said Empire will allow doctors to provide additional information that could allow them to qualify for better reimbursement, even if at first they fall short.
We also recognize that claim data is not always perfect, Breidbart said. We do give doctors the opportunity to point out where we may be missing information.
If I don't trust my doctor to make the right call for me, I'll get another doctor, thank you very much. I don't need bureaucrats anywhere dictating what he should do.
I wonder if I can cough up enough to buy back my own records and take myself out of the system.
Hmmm... Generally “best practices” as defined by the insurer (private or gubmit) comes down to refusing to pay for tests that come back negative.
So two men come in with identical chest pain complaints. They both get a series of tests to check for heart problems. One comes back positive and one comes back negative. The insurer decides that the doctor only practiced “best practices” on the one that “actually needed the tests”.
The convoluted logic is that eliminating a diagnosis is bad medicine, and the net effect is more dead people.
Sounds like Health Care Rationing.
I wonder if the Business Socialists will decry this Rationing as they do with ObamaCare.
ObamaCare rationing is wrong...as well as this rationing. Socialism by any group is still socialism.
This is the kind of thing that emboldens and empowers the Goverment funded Socialized medicine....like the HMO Rationing that was done a few years ago
Are there available untapped resources in capitalist America today to provide every single American with all the health care services that he or she desires to consume?
If “yes” then there must be a straightforward way to distribute those services to the consumer... conservatives and liberals are warring needlessly.
If “no” then somehow there must be a way to determine who will get fewer services than they desire. The market will do it in the case of private enrollees, the government must do it in the case of its enrollees.
This is simply a pay for play scheme. Bribes for denying proper medical care.
I should have added that these schemes NEVER focus on actual outcomes, i.e., whether the patient got better or not, but always focus on the AMOUNT of medical care involved, e.g., number of tests, number and length of consultations, whether cheap drugs were prescribed in lieu of ones that actually work, etc.
You don’t suppose the chosen metric is any indication of what the insurance company is REALLY interested in, do you? Naaaaa.
“This is simply a pay for play scheme. Bribes for denying proper medical care.”
Your comment needs repeating! Well said.