A Great Experiment

Everybody wants it. Better health care results for less financial outlay, that is. It's so high on most people's lists that it pulls even in their estimation with the Holy Grail of health care: universal care.

This is why an examination of a demo project being run by the Centers for Medicare and Medicaid Services is well in order. While the results so far are neither large in scale nor conclusive, they do show a consistent trend in the desired direction. The approach is a logical one. They are trying to re-leverage the system of incentives used in health care.

The current incentive system is, as stated by George C. Halvorson, "perverse." This project is testing out a different approach, one in which incentives are are earned by hitting a series of quality benchmarks. There are ten group practices involved in the program.

Vi Anna Wilde Matthews of The Wall Street Journal's Health Blog:

The groups scored nearly perfectly on quality measures for diabetes, heart failure and coronary artery disease, with half achieving the targets for all 27 bogeys, and all of the groups meeting at least 25. But only four achieved the CMS efficiency targets and won the extra payments tied to saving the government money and achieving quality standards. See more details by clicking here.

The savings were measured in a typically convoluted way-– the doctor groups got the bonus if the growth of the demonstration participants’ Medicare costs was at least 2% slower than the growth for other beneficiaries in their geographic areas.

John Pilotte, the CMS project director for the pilot, told the Health Blog he felt the savings results were still “very positive,” and better than the first year, when just two groups achieved the goal. Still, he added, “it sort of underscores the challenges and the difficulties in managing care for the Medicare population.”

Nothing is perfect and all things take practice. With the program still in its early phases but already showing measurable improvement, I would say this is one worth watching.

SOURCE: "In Experiment, Doctors Save Medicare Money While Improving Care" 08/15/08
photo courtesy of takomabibelot, used under its Creative Commons license

Rewarding Primary Care Providers for Excellence

In an ambitious effort to shore up U.S. primary-care medicine, a coalition including General Electric Co., International Business Machines Corp. and Verizon Communications Inc. is launching an initiative to pay doctors hefty bonuses for creating "medical homes" for patients.

So begins Vanessa Fuhrman's article in today's Wall Street Journal. The program she is speaking of is called Bridges to Excellence, a major mover when it comes to doling out financial incentives to doctors for increasing quality of care. Active in 18 states nationally, it paid out approximately $10 million in bonuses to doctors last year.

[...] doctors can receive $125 annual bonuses for each patient covered by a participating employer, up to a maximum $100,000 a year. Based on previous work with doctors' practices, Bridges to Excellence executives estimate such improvements in quality save $250 to $300 per patient in the first year.

"We know that in year one, the savings are there, so let's share half of that with physicians," says Francois de Brantes, the program's chief executive.

[...] It is also intended to help reverse the sustained decline of primary care in the U.S. Struggling against rising costs and a payment system that rewards procedure-based specialist care over spending time talking to patients and basic preventive medicine, family physicians and internists increasingly have had to squeeze in more patients for less pay.

In our current health care environment, as Mr. Halvorson points out in his book, there are over 900 billing codes for medical procedures and yet not one for a cure. Prevention simply is not as profitable. A financial incentive to doctors may be the shot in the arm our ailing system needs.

[...] the average American spends fewer than 30 minutes a year with a primary-care physician -- half as much time as patients in other developed nations -- a recent study in the British Medical Journal found. Doctors say that isn't nearly enough to head off preventable health problems or manage chronic illness.

"In order to fix this mess, we have to thoughtfully reshape the payment environment," says Bruce Bagley, medical director for quality improvement at the American Academy of Family Physicians. "Right now, we're getting exactly what we're paying for."

Since chronic illnesses account for roughly 75% of all health care expenditures, anything that helps shift the focus to preventative diagnosis and treatment has the potential for extensive long-term savings.

SOURCE: "Group Offers Doctors Bonuses for Better Care" 01/31/08

photo: screencapture of the Bridges to Excellence Website