MAY 17, 2012

Welcome to the Pay for Performance Update eNewsletter
This issue sponsored by the Pay for Performance Summit

GAO: CMS Quality, Efficiency Incentives Slowed by Fraud and Abuse Laws
The Government Accounting Office has advised that innovative delivery and payment reforms outside of CMS demonstrations and accountable care organizations participating in the Medicare Shared Savings Program are not exempt from laws aimed at preventing fraud and abuse. The GAO specifically referenced the Stark Laws, the anti-kickback statute and Civil Money Penalty law. While the climate by be changing, thus far the laws are not. (Inside Health Policy, May 16, 2012)

Medicare Advantage Star Ratings: Detaching Pay from Performance
Because the data used to award "star ratings" for Medicare Advantage plans are not published until after the performance period the plans will not be able to improve their performance to achieve the goals CMS intends. Patients who are rewarded for choosing plans CMS favors based on these results may be doing themselves a disservice. (American Action Network, May 15, 2012)

Rewarding Healthy Behaviors--Pay Patients for Performance
This essay suggests that the research does not show significant effectiveness from the investments in conventional pay for performance and proposes a pilot study in which patients are incentivized for healthy behaviors involving compliance matters (e.g., office visits, medications, etc.). (Annals of Family Practice, May/June 2012)

Pay-for-Performance-for-Patients: Implications for HIV Care
In a similar story, Medscape Education interviewed Jane M. Simoni, PhD, of the University of Washington, and Sally L. Hodder, MD of the New Jersey Medical School, about approaches to contingency management and P4P4P (pay-for-performance-for-patients) as the concept relates to HIV patients. Nearly 3 out of 4 living with HIV do not have the disease under control. This link is a portal to CME opportunities for physicians and nurses. (Medscape, April 30, 2012)

Bonuses for Docs Do Little to Improve Diabetes Care
Systems that offer minimal incentives to physicians to improve care, reduce errors and save money do not seem to be effective concludes Reuters in response to a Canadian study (http://care.diabetesjournals.org/content/35/5/1038) involving the care of diabetes patients. These findings confirm the results of similar studies. The medical home offers promise as do P4P systems that influence a larger portion of the physician's income, says Dr. Michael Parchman, director of the MacColl Center for Health Care Innovation at the Group Health Research Institute in Seattle, who was interviewed by Reuters. (Reuters, April 26, 2012)

Panelists: Pay-for-Performance Will Change Health Care
A multidisciplinary panel of providers gathered in Westchester County New York to discuss the future of healthcare. John Schandler, President and CEO of White Planes Medical Center, noted that every new managed care contract they enter into is performance-based. Dr. John Murphy, CEO of Western Connecticut Health Network said, "We have to focus and celebrate empty beds in a hospital as opposed to full beds in a hospital. The incentives have to lead the way...I think the incentives have to reward keeping people well." (Fairfield County/Westchester County Business Journal, May 8, 2012)

Making the Best of Hospital Pay for Performance
Believing that hospital pay-for-performance is a fixture of the future the authors of this NEJM Perspective urge cooperative efforts to make Value-Based Purchasing "as good as it can be." They advise pursuing three strategies: 1) learn how hospitals learn, 2) ensure that fiscal side effects are monitored, and 3) make improvements as quickly as possible (New England Journal of Medicine, April 26, 2012)

Pay for Performance: Refining the Bonus Structure to Meet Market Realities

In this podcast Julie Hobson, Highmark's manager of provider engagement, performance and partnership, describes their Quality Blue physician pay for performance program and offers some lessons Highmark has learned about engaging physicians in pay for performance.

To update or remove your address, please click the "Unsubscribe/Manage" link below or email your request to: listmgr@HealthcareeNewsletters.com.

Pay for Performance Update e-Newsletter is one of a family of free e-Newsletters providing a complimentary video presentation and regularly updated news and key resources on major health care issues such as ACOs, comparative effectiveness, patient safety, bundled payment, readmissions, and Medicaid. To view and subscribe to other e-Newsletters go to www.HealthCareeNewsletters.com.

Historical Perspective on Healthcare Payment in the U.S.

Paul B. Ginsburg, PhD
Center for Studying Health System Change, Washington, DC