Monday Musings

Last month I focused on healthcare reform initiatives focused on how quality measures will be front and center in the move from volume based care to value based care by CMS. Performance on quality measures is also going to be used to determine physician compensation packages and contracted payment rates from private payers.   It is becoming increasingly common for physician groups to reward certain quality metrics as part of their internal reimbursement structure.

The American College of Medical Practice Executives’ (MGMA-ACMPE) publishes a physician compensation and production survey. They reported that in 2014, 3% of primary care physicians and 2% of specialist total compensation were based on quality measures. Recruiting firm Merritt Hawkins reported that 39% of the 2013 physician positions that offered a productivity bonus included payments based on quality metrics. That’s up from 7% in 2011 so the pace of this change is rapid.

This shift in payment structures is a reflection of the transition the healthcare marketplace is making – away from paying for volume in favor of rewarding quality.  It only makes sense for medical groups to evaluate ways to align their compensation models with the way revenue will flow into the practice, which may now include incentives for patient satisfaction, quality of care, and cost containment. If we are going to get paid based on value, then those value components will have to be part of the incentive package.

What metrics should a wound care clinician select upon which to be rewarded? Craig Samitt, MD, executive vice president of HealthCare Partners in Torrance, California is also a commissioner of the Medicare Payment Advisory Council.  He recently observed that, “The measures need to be reliable, reproducible, measurable, and valid—and that can often be the hardest challenge because there aren’t many proven quality measures that apply to each and every physician.” I am paying attention to this because my hospital system has created an Independent Practice Association (IPA) and they want me to join it. I asked them what quality measures they would use to assess my quality of care and because my boards are in Family Practice, the IPA representatives were happy to tell me that I’d be measured on blood pressure control, breast and colon cancer screening, and immunization status. So, I asked them if I could use quality measures from the US Wound Registry to demonstrate my wound care expertise. That was 4 months ago and they are still scratching their heads. It SEEMS like a great idea, and there ARE other wound care practitioners in their system. The “one size fits all” quality measure approach is NOT going to work for all doctors. More next week.