State Rewarding Doctors for Quality Care
By MATTHEW PERRONE
WASHINGTON – More than half of all U.S. states reward doctors for delivering high-quality care to patients in government health care programs for the poor, according to a survey released Thursday.
The survey’s findings suggest states continue to move faster than the federal government to adopt pay-for-performance measures aimed at encouraging physicians to deliver high-quality health care that is cost effective.
Almost 85 percent of state Medicaid programs plan to have pay-for-performance measures in place within five years, according to figures from the Commonwealth Fund, a private foundation that finances health care research. The group says the survey of all 50 state Medicaid directors is the first nationwide review of pay-for-performance trends in the health care program, which covers 55 million low-income Americans. Medicaid is funded by both the federal and state governments, but it is managed by separate state officials.
The American Medical Association and other physician groups have stressed that doctors should play a major part in designing measures that are used to promote better medical care.
"Physicians are dedicated to providing high quality care to their patients, and pay-for-performance programs may help if they are designed with quality improvement as the primary goal," said Dr. Cecil Wilson, chairman of the AMA.
Many physicians are concerned that pay-for-performance measures favoring cost savings over quality could actually make care worse.
The Commonwealth Fund study comes a week after Medicare officials unveiled a program that allows physicians to earn bonus payments for recording certain quality-promoting measures when they see patients. Physicians are not required to participate in the program, but Medicare officials say the initiative represents a major step toward promoting higher-quality care.
More than 43 million senior citizens are covered by Medicare, which, unlike Medicaid, is solely managed by the federal government.
Independent government advisers told Congress last year that Medicare’s current system of paying a set fee for individual medical services encourages unnecessary care and excessive, high-cost procedures. The Institute of Medicine recommended that Medicare transition to a pay-for-performance system by cutting base payments to doctors and hospitals and using the savings to reward them when they follow practices that improve patients’ health.
The recommendation drew criticism from hospital and physician associations, which said their members already face steep payment cuts from the government entitlement program.