This is the third blog I've written on this topic.The current issue (April 11, 2005) of the AMA Medical News reports on United Healthcare 's "Performance Program". They have implemented some type of measurement system which designated physicians as "performers".
If you are not so designated, according to the AMA News report, you are virtually delisted.Critics of the program,which is almost everyone,(included the AMA and several local medical societies) claim that the classification is based on cost- not quality. Many (actually most)of the physicians on the UHC plan don't meet the volume criteria to be ranked and if they not ranked they cannot be "performers".If you are not a performer,so defined,patients have to pay more to see you.
Doctors affiliated with the Barnes-Jewish Hospitals in St. Louis have threatened to drop UHC as only 18% of its 4,000 doctors were designated as performers.
This is exactly the type of semantic smoke and mirrows maneuver that one has come to expect from insurance plans.Pay for Performance was touted as rewarding physicians for quality work and what we get is some non transparent system which punish doctors based on cost issues and sugar coats the program with performance rhetoric.
An editorial in the same issue says in part "the physician community has the opportunity to help shape its (pay for performance) direction." Wouldn't it be nice to think so? The physicians who are part of the UHC plan had about as much opportunity to shape that plan as the UHC patients did, namely none and both groups will be the losers.
The AMA has proposed 5 principles for pay-for-performance programs.They are: ensure quality of care,foster the Dr-Patient relationship,offer voluntary participation,use accurate data and fair reporting (wherein docs are allowed to appeal results prior to the use of the results for programmatic reasons), and provide fair and equitable program incentives.Details of each element are found on the AMA website and they seem to bear no resemblance to what UHC has rolled out, surprising to only the very naive.(Remember the quality enhancement that resulted from the gate keeper initiative of the managed care companies)
After the fact the AMA and others complain about it.As the saying goes "The dogs bark but the caravan moves on".