Comments on: Pay For Performance: From Quality To Value

By: mmaglothin

mmaglothin — Fri, 24 Oct 2008 23:31:03 +0000

OIG Approves Gainsharing Program for Ortho and Spine
AUGUST 14, 2008

The OIG has approved the first orthopedic and spine gainsharing project.

No details have been released on the participating hospitals or the particular procedures and technologies that will be covered in the project. Additionally, no financial terms have been publicized, though the Goodroe press release says that most arrangements allow participating physicians to be paid as much as 50% of the savings generated under the program. According to Goodroe, up to $75 million in potential savings has been identified in the existing programs, so these benefits could be significant. A 2006 survey found that most physicians felt that gainsharing was an effective way to align financial incentives for hospitals and physicians, though they were divided on what constitutes gainsharing and whether it should be disclosed to patients.

In her guest blog for HealthpointCapital, Goodroe Healthcare Solutions founder Joane Goodroe commented, “Gainsharing is first about assuring quality of care for patients and secondly about increasing efficiency.” Industry groups such as MDMA and AdvaMed have taken issue with these objectives, suggesting that gainsharing may reduce the quality of patient care, slow development of new technology and discriminate against smaller manufacturers.

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I’ve present Gainsharing to MGMA Annual, BONES, MGMA FMS and MSO Societies.

The docs have to approach the hospital – the hospital is not going to be very aggressive about sharing their savings.

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Marshall Maglothin MHA MBA
President, Blue Oak Consulting, LLC
COO, Inpatient Specialists, P.A.
Fairfax, VA / Rockville, MD
mmaglothin@cox.net

By: jimdunn

jimdunn — Tue, 17 Jun 2008 08:27:05 +0000

i do agree with James C. Robinson that the meaures that have been used in P4P programs are extremely deficient. the main party who is to enjoy all that is the consumer.

……………………………………………………………………………………………………………

jim dunn
Alabama Treatment Centers
http://www.treatmentcenters.org/alabama/

By: drogersmd

drogersmd — Mon, 16 Jun 2008 23:24:41 +0000

I beg Professor Robinson’s pardon. If you look at data from the Medical Group Management Association (MGMA) over the last several years, you will see that the average cost/RVU for most multi-specialty groups is actually greater than the Medicare RVU conversion factor (reimbursement $/RVU), which means that what we really have here, in the case of Medicare, is NON-PAY for PERFORMANCE for several years now. And the private payers are following closely behind.

Physicians who understand this are dropping Medicare in increasing numbers. What does this do to the “value” or “quality” or whatever you wish to call it, of the care everyone receives?

By: James C. Robinson

James C. Robinson — Mon, 16 Jun 2008 16:55:42 +0000

I agree that the data and measures used in P4P programs are deficient in the extreme. One wonders who to blame: Medicare, the penultimate responsible for long term outcomes, who pays resolutely on a FFS basis? The consumer, the ultmate responsible and beneficiary, who might want to invest in prevention and quality-tracking and price-conscious demand even if not subsidized by insurance? And of course the American Question: what’s the alternative? We tried P4NP (pay for non-performance) for many years, with modest results, and seem to be heading towards NP4NP (non-pay for non-performance).

By: Ted Sekscenski

Ted Sekscenski — Mon, 16 Jun 2008 01:53:32 +0000

I am not sure what Jamie Robinson meant by “value” being a “felicitous” term to apply to health care. The best “definition” I have heard of the term regarding health services was by Denis Cortese, M.D., CEO of the Mayo Clinic, in a presentation made at the National Press Club. He noted he was in the habit of buying a brand of shoes that although more expensive than others on the market, lasted much longer, were more comfortable, and more suitable, at least to his tastes. To translate this into health care terms, value he said is something that is better measured in the longer term, as opposed to performance, that is measured largely in terms of episodic care delivery. This definition is helpful when considering what is paid for in health care. While it “does not pay” for a provider to cover the costs of some care that may have a benefit years from when it is provided, and the consumer has moved on to another provider; it does “pay” from the perspective of the health care system and the consumer to have this care delivered when it will offer the most long term benefit. Our delivery systems, payment systems, and measurement systems should take this longer term perspective into account when estimating the “value” of health care. Most systems today pay and measure care performance on an episodic basis. I think a change to a value-based system of care would be most felicitous (appropos) indeed.

By: richard smith

richard smith — Sat, 07 Jun 2008 01:44:59 +0000

A requirement to be a card carrying memberof the heathcare consulting industrial complex: spend a 48 hour period at the elbow of an intern or residient physician at any sizeable city/county hospital. Blood. Broken bones. Vomiting. Vomiting blood. Raging anger. Violence. Wild on crack, etc. Unregulated. Designer letterhead. Little more.

By: drogersmd

drogersmd — Tue, 03 Jun 2008 10:56:44 +0000

Professor Robinson writes elegantly about P4P from the perspective of health economics academia but I am not sure he really understands the real, ugly truth about current P4P programs. As currently used in virtually every P4P program, performance is based on cost data which is obtained through claims processing and billing information. This would be like judging the quality of the produce at the supermarket by looking at the price at the register. While it is intuitive that a 10 cent banana might actually taste like one, somehow we seem to accept the premise, promoted by CMS and commercial payers alike, that lower cost means higher quality. And it would be easy to write elegantly about the economics of the cost of produce, looking at the cash register receipts; but would one really be able to understand the variables related to quality without actually visiting the produce department? I don’t think so.

Another common mistake is to imply that “sustainable insurance expansion” is the same as expanded healthcare. Health insurance does not ensure health care. In fact, the astounding rate of rising health insurance premiums in the private world continues, while the actual rate of rise in medical care costs has declined for the last one or two years.

If every healthcare economics professor would spend a day or two in the billing office of one of their own personal physicians, he or she would have a new perspective on what it takes to render quality medical care to real patients in real time. I know they can understand the concept of “lowest common denominator,” which is where we are all headed in terms of health care quality, especially if we embrace P4P programs based solely on billing data.

By: Pay For Performance: From Quality To Value · Blogtica.com

Pay For Performance: From Quality To Value · Blogtica.com — Thu, 29 May 2008 16:41:32 +0000

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