Braving the New World of P4P ! Tiffany Berry, MD Medical Director of Quality & Patient Safety Scott & White Healthcare Assistant Professor Family Medicine.

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Presentation transcript:

Braving the New World of P4P ! Tiffany Berry, MD Medical Director of Quality & Patient Safety Scott & White Healthcare Assistant Professor Family Medicine TAMHSC

Objectives… What is Pay for Performance? How will primary care be measured? What are the current plans for reimbursement change?

Snapshot of P4P… Rewards Quality not Quantity Do Good = Do well More than ½ of private health plans use P4P in their provider contracts

PPACA established the Center for Medicare and Medicaid Innovation. Gives broad authority for the HHS secretary to test innovative payment methods for medical homes that provide patient- centered coordinated care and for bundled hospital acute and post-acute care. Nearly all health care opinion leaders (97%) support reforming provider payment to promote quality and efficiency Stimulating Provider Payment Reform…

HHS secretary is tasked with developing a National Strategy to Improve Health Care Quality Requires public reporting of physician quality and patient experience measures through the "Physician Compare" Web site for Medicare beneficiaries. Promoting QI & Public Reporting

Inventories of programs across all types of payers document more than 100 pay-for- performance programs In a national survey, 52% of HMOs (covering 81% of enrollees) report using pay-for- performance Baker G, Carter B. The Evolution of Pay for Performance Models for Rewarding Providers. In: Introduction to Case Studies in Health Plan Pay-For- Performance. Washington, DC: Atlantic Information Services; Rosenthal MB, et al. Pay-for-Performance in Commercial HMOs. New England Journal of Medicine, in press. Who really does this?

So…this is a good thing? No measurable impact on cost thus far Unintended Outcomes: – Reward Process not outcomes – Encourage providers to « cherry pick » – Discourage treating the underserved