Tuesday, March 29, 2005

Pay for Performance, Part 2, watch the Medicare Payment Advisory Commission

MedPAC is the acronym for the Medicare Payment Advisory Commission.Physicians need to listen to what they are saying. "Physicians are ready for a pay-for-performance program " said Karen Milgate, a MeDPAC research director at a recent meeting which precedes the March report to Congress.Ms.Milgate offered no data to support her statement.
MeDPAC's web site has the biographies of the Commission.The commission has its share of attorneys (who better to determine how medicine will be practiced.)The American College of Physicians is represented.Their envoy, Dr. Alan Nelson is quoted in the March 15, 2005 issue of Internal Medicine News "...the insistence of payers for incentives to promote quality is something that cannot be ignored." (Practicing physicians know well that payers are all about promoting quality,not about saving money at least in the world where pigs will fly.)There are 3 attorneys on the commission and the VP of Humana,CEO of a medical supply company (DeRoyal) and the Executive Director of the Permanente Federal of Medical Groups,and assorted medical policy and public health wonks.
Ms. Milgate suggests linking prescription data with physicians claims to determine whether the patients received "appropriate pharmaceutical care".Here's a new term to me, "pharmaceutical care ".I'll wager if this very coarse grain analysis concludes that care was not appropriate, it will be the fault of the physician not the drug store employee.
One Commissioner,Dr.Nicholas Wolter,who seems to be the only person on the panel in private practice said "pay for performance might be another irritation,rather than an incentive" and added in regard to whether physicians are ready "I'm not sure that's true".Dr.Wolter seems to be a master of the understatement.
The commission report is available on line on the MeDPAC site. The recommendations include "radiologists meet quality standards as a condition for medicare payment" and "measuring the resource use" of physicians treating medicare patients.I did not notice any radiologists on the commission and there appeared to be only one doctor who might actually treat medicare patients.

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