What's your physician worth?
Government leans toward performance-based pay
By Daniel Connolly

The Commercial Appeal
Friday, September 7, 2007
http://www.commercialappeal.com/news/2007/sep/07/b7quality/

Get ready for the day that you learn in detail how well your doctor is doing compared to others.

The government is putting increasing pressure on doctors to report data about their practices and is moving toward a system that pays them based on the quality of their work, said Dr. Susan Nedza, a Washington-based official from the federal Centers for Medicare and Medicaid Services.

And there would be greater public reporting of physician outcomes, she said.

Nedza was the featured speaker Thursday at a local conference on performance-based pay for doctors.

"Medicare is transforming from a passive payer providing services to an active purchaser of high-quality physician health care," she said after her talk at FedEx Institute of Technology on the University of Memphis campus.

Medicare, the health insurance program for those 65 and older, already publishes quality information for hospitals. Now, the agency is tackling the contentious question of how to rank the performance of individual doctors.

Details are still blurry, but doctors might be graded based on the overall health of patients with chronic diseases such as diabetes. These grades would become public and help determine how much Medicare paid them for their services.

Several factors are driving the trend. Health care costs are rising, and there is increasing demand for services. Businesses and other payers want better results for the money they pay to cover patients.

Nedza said Medicare already pays hospitals to turn in information about their patients and that this information is published. Starting July 1, the agency began paying doctors to report the similar quality data, she said.

A shift toward paying doctors based on performance would require an act of Congress, said Nedza, who is chief medical officer of a Medicare division that deals with quality issues.

The federal government isn't the only one considering grading doctors based on patient outcomes.

BlueCross BlueShield of Tennessee plans to launch pilot pay-for-performance programs by late 2008, said Allen Naidoo, director of medical informatics for the insurer. Representatives of other insurers announced similar plans at the conference Thursday.

Also, the Healthy Memphis Common Table initiative is trying to bring together doctors, insurers and others involved to discuss how to move forward on the issue in the Mid-South, said Cristie Upshaw Travis, CEO of the Memphis Business Group on Health.

-- Daniel Connolly: 529-5296