Care Patterns in Medicare and Their Implications for Pay for Performance (original) (raw)
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Assessment of Pay-for- Performance Options for Medicare Physician Services: Final Report
In recent years, pay-for-performance (P4P) programs have been developed as a strategy for driving improvements in the quality and cost-efficiency of health care. The Centers for Medicare & Medicaid Services (CMS), is actively considering P4P for Medicare physician services, viewing this policy strategy as one way to increase physician responsibility for efficiently providing high quality care to beneficiaries of the Medicare program.
2000
PROLOGUE: Notwithstanding its maiden promise to keep government's hands off the health care delivery system, Medicare began efforts to restrain runaway spending long before the managed care boom of the 1990s. With 85 percent of beneficiaries still receiving fee-for-service care, those efforts are destined to continue well into the future. Neither Medicare nor private insurance has yet solved the age-old contradiction between patients' and providers' demand for more and payers' need for restraint. The chimerical notion that all of these imperatives could somehow be aligned in a common scheme still floats beyond reach.
Changing physician payment for Medicare patients. Projected effects on the quality of care
The Western journal of medicine, 1986
Congress and the Reagan Administration, in an effort to "contain" costs, are considering changes in the way physicians are paid when they care for Medicare patients. By examining the effects on quality of care of several alternative ways physicians might be paid, including modified fee for service, physician diagnosis-related groups and capitation through health maintenance organizations, we can predict the kinds of effects on quality of care most likely to occur and the kinds of patients most likely to be affected. Under each of the payment alternatives, poorer and sicker patients are at greatest risk for reduced access to care and quality of care. These findings underline the need for rigorous experiments to assess the effects of changes in physician payment on quality of care and the need for monitoring and assurance of quality in a new payment system.
Journal of General Internal Medicine, 2006
Recent research underscores the gaps that exist between evidence-based medical practices and the care that many patients actually receive. Recognizing this, large purchasers are experimenting with new reimbursement arrangements called pay-for-performance (P4P) that tie a portion of payments for physician services to measures of quality. Agency theory, from the discipline of economics, provides a perspective on the challenges P4P is likely to encounter. The focus of most P4P initiatives on medical group performance raises additional questions about its potential effectiveness as a catalyst for change.
Bringing managed care incentives to Medicare's fee-for-service sector
Health care financing review, 1996
The Health Care Financing Administration (HCFA) could work with eligible physician organizations to generate savings in total reimbursements for their Medicare patients. Medicare would continue to reimburse all providers according to standard payment policies and mechanisms, and beneficiaries would retain the freedom to choose providers. However, implementation of new financial incentives, based on meeting targets called Group-Specific Volume Performance Standards (GVPS), would encourage cost-effective service delivery patterns. HCFA could use new and existing data systems to monitor access, utilization patterns, cost outcomes and quality of care. In short, HCFA could manage providers, who, in turn, would manage their patients' care.
JAMA health forum, 2021
IMPORTANCE The Merit-based Incentive Payment System (MIPS) is a major Medicare value-based purchasing program, influencing payment for more than 1 million clinicians annually. There is a growing concern that MIPS increases administrative burden, and little is known about what it costs physician practices to participate in the program. OBJECTIVE To examine the costs for independent physician practices to participate in MIPS in 2019. DESIGN, SETTING, AND PARTICIPANTS This qualitative study identified and interviewed leaders of physician practices participating in the US Centers for Medicare & Medicaid Services (CMS) MIPS program, including those in MIPS alternative payment models. Time required and financial costs were calculated from responses to in-depth, semistructured interviews conducted from December 12, 2019, to June 23, 2020. Physician practices were categorized by size (small, 1-9 physicians; medium, 10-25; and large, Ն50), specialty (primary care, general surgery, or multispecialty), and US census region. Participants were asked about 2019 costs related to clinician and staff time, information technology, and external vendors. Time was converted to financial costs using the Medical Group Management Association's Provider Compensation and the Management and Staff Compensation databases. MAIN OUTCOMES AND MEASURES Annual time spent by staff on MIPS-related activities and mean per-physician costs to physician practices in 2019. RESULTS Leaders of 30 physician practices (9 [30.0%] small primary care, 6 [20.0%] small general surgery, 4 [13.3%] medium primary care, 4 [13.3%] medium general surgery, and 7 [23.3%] large multispecialty) represented all US census regions, and 14 of the 30 (46.7%) practices participated in a MIPS alternative payment model in 2019. The mean per-physician cost to practices of participating
The Promise and Pitfalls of Explicitly Rewarding Physicians Based on Patient Insurance
Journal of Ambulatory Care Management, 2000
In a large multi-specialty group practice treating approximately equal numbers of health maintenance organization (HMO) and fee-for-service (FFS) patients, we analyzed a natural experiment by the administration to introduce a dual incentive system for physicians. We examine the impact on care when they announced that each physician would be remunerated for HMO care based on a per capita budget, but for FFS care based on billable services. Data were 86,230 episodes for treating patients under age 65 with seven common illnesses. There was no evidence that the intended impact (reducing HMO care) occurred; instead, there were undesired and unintended effects (reduced care for FFS and upset physicians and threats to their corporate culture).