Another change on the horizon.
http://www.medscape.com/viewarticle/513917?src=mp
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Pay-for-Performance Has Quality-Improvement Potential, AAFP Says
Bonnie Darves
Oct. 3, 2005 (San Francisco) — Despite the concerns that the medical community has expressed about the burgeoning pay-for-performance (P4P) movement — lack of standardized measures, the burden of data collection, and the "nonquality" factors driving the model — family physicians should prepare to participate in P4P programs for the noneconomic benefits their practices may accrue, according to Bruce Bagley, MD, the American Academy of Family Physicians (AAFP) medical director for quality improvement.
"The point is to encourage physicians to start collecting [performance] data prospectively —whether they're using a paper-based checklist or a computerized method," Dr. Bagley said, because performance measurement is clearly on the rise and family physicians in even nonurban U.S. regions are likely to see P4P programs emerge in the near future.
Speaking to attendees here at AAFP's Scientific Assembly, Dr. Bagley and other presenters discussed the advantages and disadvantages of the P4P movement and discussed AAFP's current and planned resources designed to help members prepare their practices for P4P participation. Dr. Bagley acknowledged that the biggest roadblock in P4P is the lack of standardized measurements, an issue that has emerged as a chief concern among physicians.
"That's really the No. 1 issue — to get all of the entities [health plans, purchasers, and the government] offering P4P programs to adopt the same standardized measure sets," he said, an effort that the AAFP, other physician organizations, and the National Quality Forum, among others, are pursuing. "Right now, for example, we've seen as many as eight to 10 diabetes [management] performance measurements — so what we have said is that we need standardized ambulatory measures, and we need them now."
An estimated 100 P4P programs are now in operation nationwide, and AAFP's concern is that continuing rapid proliferation of the programs could stymie efforts to standardize measures. In a recently issued policy statement, Dr. Bagley noted, the organization called for standardization and consistency of measures, as well as consolidation of P4P programs across employers and health plans to make associated bonuses more meaningful and programs more practically manageable for physician practices.
For example, the way some programs are currently structured places a substantial data-collection burden on family physicians — necessitating retrospective chart review by either practice staff or outside individuals involved in the programs — without a commensurate reward, Dr. Bagley noted. "Retrospective chart review is expensive, burdensome, and it doesn't work," he said.
By moving instead toward prospective data collection, and providing family physicians tools to assist in that effort, the programs are more likely to achieve the twin goals of improving care quality and outcomes. "We need to begin by providing incentives for process improvement before focusing on outcomes. If we can incentivize process improvement for two or three years, then we can move to outcomes — when the majority of practices have [data collection] processes in place," Dr. Bagley said.
AAFP President Mary Frank, MD, concurred, saying that family physicians — and those who offer P4P programs — need to view them "first as quality improvement and then as financial recognition." She also said that family physicians, who, like other primary care providers, are essentially the "reality test" for such programs, should be involved in discussions with employers and insurers who are designing programs. Dr. Frank called for structures that reward incremental improvement, so that participants don't have to "go from 1 to 100" before they earn financial rewards for improved performance.
"There is a lot of concern that P4P — and practices such as provider tiering — are about efficiency and cost only," Dr. Bagley said, adding that the physician community will need to be convinced otherwise if they are to become active participants in P4P programs.
For its part, the AAFP is moving forward on several fronts to offer resources to help members prepare for P4P participation. In addition to its involvement in national, multi-organization efforts to standardize performance measurement in targeted diseases or conditions, in September the AAFP unveiled its Practice Enhancement Program. The interactive, hands-on course — in which both physicians and their clinical and nonclinical staff participate — recently completed pilot testing and will be available in early 2006. The course provides tools and strategies for implementing the planned-care model, which focuses on practice redesign and process improvements that lead to improved efficiency and care outcomes.
AAFP 2005 Scientific Assembly. Presented Sept. 28, 2005.
Reviewed by Gary D. Vogin, MD
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