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Linking physician payment and quality

. 4 Comment(s)

The Los Angeles Times reports on the payment reform proposal released by Senators Baucus and Grassley of the Senate Finance Committee:

Pushing to change how medicine is paid for as part of a sweeping overhaul of the nation's healthcare system, two leading senators offered a plan Tuesday to pay more to hospitals and doctors who meet federal quality standards and penalize those who do not. . . .

In addition to promoting quality standards, Baucus and Grassley have proposed pay incentives to encourage primary-care physicians to manage a Medicare patient's dealings with multiple providers.

And their memo suggests that the amount private insurers receive from the federal government for offering Medicare coverage to seniors could be linked to some quality measure.

How should payment be linked to quality of care?   How can we shift from a volume-based payment system to an outcomes-based system?   Is that the best way to incentivize high-quality care?

Share Your Comments


  1. Frank Lonergan, MD


    Condition specific capitation linked with specific quality goals makes the most sense to me. The capitation rate could be based on the risk factor analysis RAF score) already being used in Medicare Advantage plans. However there are 2 caveats. Since most care in the US is still provided by very small groups of physicians, this type of payment system would require a few years to generate the level of consolidation required for success. In the Managed care days this took 3-5 years. Second, in addition to quality measures which remain only loosely connected to cost and outcomes measures, the groups participating in this form of capitation need to also meet financial targets such as hospital days per thousand, PMPM cost of care adjusted by severity index, etc. for the system to work.

  2. Owen Linder MD


    Medicare Advantage as I practice in it includes safeguards against risk. It works whether you are in a group of not. You just have to be a smart clinician. Reinsurance is offered by insurance business people for costly cases over anywhere from $30,000 to $75,000 and probably other levels. It is not the numbers. It is 1) the transparency, 2) the number of hands taking away parts of the funding.

  3. Marcy Zwelling


    I sorely disagree with the Senate policy report and Dr. Lonergan. managed care is a disaster and patients are leaving that system. The ACO methodology proposed by Congress, is HMO medicine government style. Physicians should be able to do their professional best for the patients and be paid directly in part by the patient.

    Quality measures have also proved to be a failure. P4P does nothing more than pay for more paperwork and take the physician away from our patients.

    Every patient I see in my office requires their own individual attention and needs. Population based, capitated care is NOT something anyone would want for their family or friends.

    Let's act professional and work for our patients more directly to get them the care they need.

  4. Extenze


    Generally I do not post on blogs, but I would like to say that this post really forced me to do so! really nice post.

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