Want to simultaneously improve the quality, cost-benefit and access to care? This can only be accomplished if health care is less fractionated, the incentives are aligned and someone is measuring and managing--in other words, pay for performance (P4P).
practice, performance and pay
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Identifying Potentially Preventable Readmissions Obeys Willie Sutton's Law--Go where the money is!Abstract"Efforts are under way nationally to reduce avoidable hospital readmissions by changing payments to hospitals, but it is unclear how well or how quickly these policy changes will produce widespread reductions in hospital readmissions.
Paying healthcare practitioners fairly is the crux of healthcare payment reform. Here is a brief synopsis of how methods to reign in physician compensation have always failed is that nothing has worked. In brief, various attempts "Reforming Medicare's Physician Payment System" have fallen flat.
Dear Doctor, "They're just kicking your Medicare fees further down the road." Attached to a bill that extends unemployment, certain other benefits and subsidies for another month is a reprieve* to this October on a threatened 21% cut in Medicare physician reimbursement. Thus, Congress again has failed to address a known flaw in the Medicare rate setting formula--the annual planned rate reduction that is deferred yearly at the last minute.
Clearly, not fulfilling patients' requests diminishes their satisfaction, but patient-centered communication can enhance that. So what is one to do? Being adept at saying "no" is an art; it should preserve, if not amplify a practitioners' interest in and concern for their patient. This article describes ways of negotiating with patients about specific requests for diagnostic testing, treatment, on-going or changing care.
You're getting squeezed and want ideas.... The recession has eroded health insurers' profits; they then lower practitioner reimbursement. Layoffs mean fewer enrollees in company-sponsored plans and less premium revenue for insurers. Reimbursement for E&M services declined by 7.3% on average; 99213, the bellwether CPT Code, fell to $65.49. E&M reimbursement for private payers declined, esp. in the Mid-Atlantic region, however it improved in Medicare.
Resource-based Relative Value Scale (RBRVS) was supposed to reduce some of the disparities in pay and encourage primary care; it has done the opposite--rewarding the more expensive care, particularly the procedures while short-changing the 'cognitive' services To quote Brian Klepper,"Medicare’s payment system, which is the basis for most commercial payment as well, favors specialists in two ways.
Snippet from "Physician Compensation, Cost, and Quality" When we look at pay-for-performance arrangements, we find, naturally, that physicians are redesigning particular aspects of their practice in order to ensure better pay, even if it is at the expense of the "quality of care in other practice areas."
Doctors who treat Medicare patients will get a 10% cut in their payments on July 1, 2008 and a 21% cut by 2010 unless Congress finds a way to make up for a budgetary shortfall. For more information related to this important topic, see my blog, "Healthcare Reform & Managed Care," on MDNG.com -- "A Nick in Medicare's Budget Cut" – Originally posted Tuesday, July 8, 2008
Higher doctor salaries may be justifiable, if the results are better. Here's why.... Caveat: To prove my contention, the following minimum information technology is prerequisite. Get all six (6) items in place and functional and the justification for higher salaries will be obvious. In other words, pay more for better care. The obverse is also true. (Rhetorically, why should we pay a lot for care that is of little or no value?)