P4P: Participation now may
pay off later
By Jennie McKee
Meeting quality indicators may
eventually affect your financial success
How do you feel about
pay-for-performance (P4P)? Regardless of your answer, it’s very
important that you realize the growing influence of P4P and understand
what P4P may require of you in the future.
A panel of experts discussed these
and other issues at the 2007 BONES Society Annual Conference. Speakers
included Tom Wolfe, administrator of Texas Orthopaedics, Sports &
Rehabilitation Associates, a 13-physician practice in Austin, Tex. that
participates in pay-for-performance; Richard M. Cameron, MHSA, CMPE,
a consultant for a healthcare consulting firm; and William D.
Darling, JD, who has practiced healthcare law for more than two
decades.
P4P: a growing trend
Under a P4P system, a portion of the reimbursement that physicians and
hospitals receive from Medicare is based on how physicians manage their
patients.
According to Wolfe, P4P
initiatives are here to stay and are continuing to proliferate.
Therefore, orthopaedic surgeons must carefully investigate and monitor
P4P to determine if participation would benefit them.
“As the Centers for Medicare &
Medicaid Services (CMS) and other insurance companies continue to design
and develop performance-based reimbursement models, practices must
realize the reality of P4P and the fact that it will change the way we
do things,” said Wolfe.
Cameron agreed that P4P
initiatives are growing at a slow but steady rate.
“In the last year we’ve seen a
substantial increase in the number of P4P programs,” he said. “Today,
there are at least 200 P4P programs in this country. A year ago, there
were about 160.”
There’s a business case for
quality, stated Darling. Better medical protocols and processes (for
example, quality indicators) lead to better clinical outcomes, which, in
turn, reduce complication rates and costs associated with care. The
combination of better clinical outcomes and less costly care results in
improved patient satisfaction.
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