Wednesday, November 22, 2006

The Daily Scan

Each morning my RSS feeds and email newsletters bring in a wealth of information on health care, medical economics, and social public policy issues. There is a great deal of "information", some of it drivel and some of it visionary. From experience we all know that well intentioned statisticians and policy makers design and implement programs that once in place have unintended secondary effects. My opinion is the "pay for performance" lies in the later category. Recently California Healthline carried the following article,

Physician Concerns Might Delay Pay-for-Performance Measures
September 25, 2006
The health care quality reporting requirements currently under consideration by Congress are "encountering resistance from physician groups, leaving open the possibility that the issue could linger on after the election" or until 2007, NPR's "Morning Edition" reports (Rovner, "Morning Edition," NPR, 9/25).House Ways and Means Subcommittee on Health Chair Nancy Johnson (R-Conn.) on Wednesday met with physician groups to discuss a proposal that would include a 1% increase in Medicare reimbursements for all physicians in 2007, with an additional 1.5% increase later in the year for physicians who agree to report health care quality information to the federal government.Senate Finance Committee Chair Chuck Grassley (R-Iowa) on Thursday said that he and ranking member Max Baucus (D-Mont.) have neared an agreement on a proposal that would reverse a 5.1% reduction in Medicare physician reimbursements scheduled to take effect on Jan. 1, 2007 (California Healthline, 9/22). According to NPR, some physicians are concerned that:
Most proposals linking quality to compensation are based on Medicare claims data;
Physicians treating Medicare beneficiaries tend to have a sicker patient population than hospitals, nursing homes or physicians who do not see as many Medicare beneficiaries; and
Medicare payments have not kept pace with medical inflation, causing medical students to not pursue specialties with longer training periods.The NPR segment includes comments from:
Paul Ginsberg, president of the Center for Studying Health System Change;
Frederick Grover, president of the Society of Thoracic Surgeons; and
Steven Nissen, president of the American College of Cardiology ("Morning Edition," NPR, 9/25).

So as one can extrapolate a 1.5% increase is meaningless, not withstanding the increased overhead it would require to implement it in the first place.

Payors are misleading businesses and employers as to what this means.


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