Private Practice Insights: Quality Pay

By Stuart A. Bussey, M.D., J.D., UAPD President

Whether you are a UAPD member in county employment or private practice you are affected by Pay for Performance.   The Hay Group recently calculated that roughly two thirds of health care organizations incorporated quality measures into physicians’ incentive programs.  If you are in such programs you need to ask yourself and your organization some important questions.  First, what exactly is being measured? Will the assessment be based on claims data or on medical record audits?  On target metrics or merely improvement?  Is the target reasonable? For instance, in my IPA the colorectal cancer screening compliance target is over 80%.  That means at least ¾ of your patients must get either endoscopy or submit occult blood smears during the year measured.  In my experience that is overly ambitious.  The next critical question is how to meet these quality measures.  Ask your organization to provide you with baseline data.  If they expect 80% compliance from you and their average is currently 25% that is not a reasonable expectation.  You should create a system in your practice-on either charts or EHR– to remind you or your staff to ask your patients to come in for an exam or test.  With many patients this can be a daunting task.  Collecting and collating all these tests and data may require additional staff or even a case manager for large practices.  Performing well on the P4P metrics is a team sport and employee reimbursement should be based on how well you all do.  The trend for P4P is definitely upward.  Forbes Insight predicts that between ¼ and ½ of physician revenue will be based on incentive within five years.