Physician Payment and Quality Measures and More

 Technical Glitches

In transferring materials from my old website to The O’ConnorReport, we hit a glitch last week (1/15)  in the electronic distribution.  For those of you who may not have received it, here is the link: http://oconnorreport.com/2013/01/the-cost-of-fraud-physician-payment-reform-and-in-the-works/#more-549

Important physician payment developments are rolling out in New York.  Here is the link to the New York Times article  if you don’t want to scroll back: http://www.nytimes.com/2013/01/12/nyregion/new-york-city-hospitals-to-tie-doctors-performance-pay-to-quality-measures.html?nl=todaysheadlines&emc=edit_th_20130112

Physician Quality Reporting System (PQRS) and Physician Payment

The new Physician Quality Reporting System (PQRS) will tie physician payments to quality indicators.  As part of the ACA,  physicians must identify this year the quality measurements they want to be ‘graded’ against for their performance.  If they do not select indicators, they will be subject to potentially stiff fines in 2015.

The physicians can choose up to three quality indicators. In the past some physicians received bonuses for having met or exceeded quality measures.

http://www.modernphysician.com/article/20130109/MODERNPHYSICIAN/301099970?AllowView=VW8xUmo5Q21TcWJOb1gzb0tNN3RLZ0h0MWg5SVgra3NZRzROR3l0WWRMWGJWZjBJRWxYek9UYktwUGZUamg5b1g4WFFERmhzbHhKSnV6Yk9XNkk9&utm_source=link-20130109-MODERNPHYSICIAN-301099970&utm_medium=email&utm_campaign=mpdaily

A current uncertainty is who will develop the quality standards and the role of the medical profession in doing so: http://www.advisory.com/Research/Health-Care-Advisory-Board/Blogs/Toward-Accountable-Payment/2013/01/The-Fiscal-Cliff-Deals-Unexpected-Impact-on-Physician-P4P

Why Quality Matters

There are tremendous variations in clinical care even for relatively common procedures, such as heart attacks.  We look here at percutaneous coronary intervention (PCI) which restores blood to the heart by opening arteries. This is often done with a small balloon and sometimes involves a stent to keep the artery open. The quicker done the better.  Here is a brief summary of 27 hospitals in Washington State.  The study was done by the Foundation for Health Care Quality, a private non-profit foundation.  The hospitals and physicians participated voluntarily.  See additional results and the Foundation’s other studies at: www.qualityhealth.org

What the following chart so graphically shows is the extensive variation in clinical practices in hospitals around one relatively small state (7 million people in the state vs.  8 million people in New York City alone).  Imagine the variations in care, and consequently higher costs and unnecessary deaths, in hospitals across the country.

http://www.hta.hca.wa.gov/documents/bree_sample_insufficient_information_report.pdf

 http://www.coap.org/participating-hospitals-publicly-released-coap-data/participating-hospitals-publicly-released-coap-data-pci

The data speak for themselves.  This is why consistent quality measures for both physicians and hospitals are so important.

Reining In Costs?

Last week we looked at the amount of Medicare billing fraud:  Over $95 billion in fraudulent billing/scams has been recovered over 10 years. Or $9.5 billion in Medicare billing alone every year for the past 10 years.

This week we found an interesting article about the Fiscal Cliff bonus for Amgen:  http://www.nytimes.com/2013/01/20/us/medicare-pricing-delay-is-political-win-for-amgen-drug-maker.html?_r=0

And a Medicare windfall for Massachusetts Hospitals—The Nantucket Effect:  http://bostonglobe.com/news/nation/2013/01/13/states-planning-legislative-fight-for-massachusetts-medicare-windfall/HV4WGdUCSOISoTxIcbwSUL/story.html

And our fight here in Washington State to gain access to insurers’ surpluses:  http://wainsurance.blogspot.com/2013/01/two-of-was-largest-nonprofit-health.html

Coming next:  a quick look at Essential benefits—they are not yet fully defined—and an attempt to sort out some of the confusion for small employers and their choices and costs.  I also want to look at some of the inherent conflicts of interest in health care policy development and advocacy.

Kathleen O’Connor, January 22, 2013

About Kathleen

Kathleen O’Connor: 30+ year health care consumer advocate, non-profit executive and author. For more information about Kathleen, please see "About" on the main content bar above.
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