P&T
Our
Other
Journal
MediMedia Managed Markets
Managed Care

 

Medicare P4P falling short on bonuses

MANAGED CARE October 2010. © MediMedia USA
Compensation Monitor

Medicare P4P falling short on bonuses

MANAGED CARE October 2010. ©MediMedia USA

Medicare’s pay-for-performance (P4P) program, the Physician Quality Reporting Initiative (PQRI), is falling short on bonus payments, according to a study in the Journal of the American College of Radiology.

Not only that, but “There’s very little transparency in the process,” says lead author Richard Duszak Jr., MD, a radiologist at Mid-South Imaging & Therapeutics in Memphis.

His medical group participated in educational programs to get ready for the PQRI initiatives, but was only paid an extra 0.36 percent of the total Medicare payment, well under the expected Medicare bonus of 1.5 percent. As a percentage of collections from all payers, PQRI bonuses amounted to just 0.11 percent, well below the estimated 1.5 percent mean increase in overall physician work necessary for participation.

After conducting its own internal audit, the medical group found that “there are still a large number of cases where we’ve reviewed our own documentation and we’ve met every requirement that Medicare has put forth, but for reasons unclear to us because of the black box of bureaucracy, we can’t get our bonus,” Duszak says. “There isn’t a mechanism to find out why.”

Despite the small bonuses, the physicians did change their behavior, says Duszak, and that is something that might be useful for health plans to note. “What we don’t know is how durable that change in behavior is.”

In general, PQRI payments are doled out only after provider groups conform to rigid documentation, reporting, and coding requirements. “If payers really want to move forward down the path of value-based purchasing, then they need to develop legitimate metrics — not just dot your ‘i’s and cross your ‘t’s — really develop metrics that physicians in the trenches perceive as being valuable.”

Summary of incremental incentive bonuses

Source: Duszak R, Saunders WM. Medicare’s Physician Quality Reporting Initiative: Incentives, physician work, and perceived impact of care. J Am Coll Radiol. 2010;7:419–424

Meetings

Pharmaceutical Pricing and Contracting Conference Philadelphia, PA September 22–23, 2014
Private Health Insurance Exchanges Conference Washington, D.C. October 7–8, 2014
National Healthcare Facility Management Summit Palm Beach, FL October 16–17, 2014
National Healthcare CFO Summit Las Vegas, NV October 19–21, 2014
National Healthcare CXO Summit Las Vegas, NV October 19–21, 2014
Innovative Member Engagement Operations For Health Plans Las Vegas, NV October 20–21, 2014
4th Partnering With ACOs Summit Los Angeles, CA October 27–28, 2014
2014 Annual HEDIS® and Star Ratings Symposium Nashville, TN November 3–4, 2014
PCMH & Shared Savings ACO Leadership Summit Nashville, TN November 3–4, 2014
World Orphan Drug Congress Europe 2014 Brussels, Belgium November 12–14, 2014
Medicare Risk Adjustment, Revenue Management, & Star Ratings Fort Lauderdale, FL November 12–14, 2014
Healthcare Chief Medical Officer Forum Alexandria, VA November 13–14, 2014
Home Care Leadership Summit Atlanta, GA November 17–18, 2014