P4P spreading like wildfire

Two reports on P4P were issued in recent weeks.  Follow the links to the P4P report form PriceWaterhouseCoopers and to the executive summary of the P4P report from MedVantage and the Leapfrog Group.

The MedVantage/Leapfrog report projected "there will be 155 pay-for-performance programs in place this year, compared with only 39 in 2003," per a Modern Healthcare article this week.

That article continues:

The [PWC] report looked at 10 different pay-for-performance programs and found that, together, they used almost 60 different physician-performance indicators, no one indicator was used by all 10 programs, and no two programs rewarded providers the same way.

Pay-for-performance programs can be an important tool to link payment to quality, the PWC report stated, "But the wide variation in program structures, performance metrics and rewards structures mutes their potential impact."

"I thought the report by PWC was pretty much on the money," said Francois de Brantes, national coordinator for the Bridges to Excellence physician-reward program. "Most of the employers and the plans we work with are increasingly cognizant of the fact that this dispersion of attention just creates a lot of noise, and that we need to strengthen the signal by having very clear standardized measures used by multiple plans and employers in a single community."

Bridges to Excellence is, of course, doing just that.  Another player in that space is Premier, which will be kicking off its QUEST P4P initiative in the near future.

If physicians can know that their performance will be measured by multiple payors against the same yardstick, they can be much more focused and efficient in their addressing of specific performance measures.  Better yet, if payors put some serious money on the table, they would tend to get physicians’ full attention (e.g., put more than 10% of compensation at risk, vs. 5% or less).

CMS will get in on the action next year, as its value-based purchasing transitions from pay-for-reporting to P4P.

There seem to be trends towards standardization of measures, though as the PWC report notes, we’re pretty far from optimal on that front.

The Modern Healthcare article jokes that the biggest winners here are the EHR companies pushing their products as the necessary means to tracking and reporting performance.

I also see organizations like Bridges to Excellence and Premier jockeying for position as keepers of the flame, bringing larger and larger numbers of providers into their respective big tents.

I still wonder whether, when all is said and done, the long-term systemic benefits are worth the exercise.  I do not doubt the benefit to the individual provider or group that meets or exceeds its performance targets and is compensated for its efforts.  I also do not doubt that "the train has left the station" (believe it or not, I’m typing those words on a train that is just leaving a station; ah, the human mind) and that P4P is here to stay, at least for a while, whether or not it is 100% analytically sound.  To take a stab at answering my own rhetorical musings, I think that when there is critical mass collected around some consensus measures (NQF or other), sufficient dollars are put at stake, and the federales jump in with both feet, we’ll start to see some systemic effects.

— David Harlow