The demand for quality in America's health care system is increasing. Traditionally a fee for service arrangement, payers are beginning initial rumblings of a system that pays physicians for an office visit and then a bonus for proper management of the patient. Great physicians will be economically rewarded and mediocre physicians will just make it. This focus on quality was initiated by the Centers for Medicare and Medicaid in 2007 with the expectation of a continued program in 2008. The senate is positioned to pass legislation today which will remove one billion dollars from the Medicare budget. On the chopping block is the 2008 program to incentivize physicians to report health quality information.Physicians participating in the 2007 PQRI program were rewarded with an additional 1.5% in reimbursement from Medicare. Naturally, this didn't have doctors knocking down doors to get this implemented in their offices, but it was enough incentive for a few early adopters to give quality a try. The program has run since July of this year and will end on December 31st. Given the need to increase the quality of care and create a more efficient system, the PQRI program has been a step in the right direction.Cutting the PQRI incentive program reduces the focus on health quality to rhetoric and removes the little progress already made. The Senate and the House found money for their political causes: $35 billion (house) and $60 billion (senate) added to the budget to cover the State Children's Health Insurance Program (SCHIP) intended for disparate kids. The new bills would have provided insurance to families whose household income could be over $80,000 annually and would draw beneficiaries out of private insurance. As easy as it was to find this money, they could not find a fraction of it to continue a physician quality improvement program. The alternative to economic reward is economic punishment. Cutting physician reimbursement until they monitor and report their quality does not necessarily guarantee compliance. The doctor's office would have the choice to comply or they could simply limit the number of Medicare beneficiaries they see to minimize the impact of noncompliance. Declining visits for Medicare patients are already being seen nationally. Cuts to the Medicare budget, and more specifically to physician reimbursement, has caused business managers to reflect on the utility of seeing Medicare patients. Medicare is a famously low reimbursing payer. Consequently, many practices are limiting the number of Medicare beneficiaries to a few each month. While there is no shortage of Medicare patients needing visits, physician's offices are limiting their visits and adding patients with more competitive reimbursement.Quality reporting, then, is best achieved by offering a small incentive and realigning Medicare as a competitive payer. The 2008 PQRI program was enhanced based on the experiences of the 2007 program. Professional organizations were gearing up to prepare their physicians to be compliant. Without the incentive, physicians literally have no reason to do more work for the same money. Dropping the incentive is the congressional way of telling physicians that they care about a patient's outcome but not enough to stall them before they leave for Christmas break.
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