for performance may well be inevitable in 2007 and 2008
-- but will it save Medicare any money?
hard to predict, say experts. It doesn't help that we can't
agree on a definition of quality, let alone whether quality
leads to lower costs, notes attorney Rebecca Burke with
Powers, Pyles Sutter & Verville in Washington. The easiest
parts of quality to define, such as information technology,
may be the ones that lead to the least savings.
physician groups fear that P4P will mean a net transfer
of funds from some specialties to others. Some specialties
have developed more detailed quality standards than others,
and some one-size-fits-all quality standards may make certain
groups look better than others.
example, neurosugery isn't tailor-made for quality-based
reimbursement, says Pat Boudreaux, data specialist with
Tyler Neurosurgical Associates in Tyler, TX. "We deal
a lot of the time with critically ill patients," who
may stay in the hospital forever no matter how good the
doctor's care is. Tyler Neurosurgical has had one or two
experiences with managed care plans' P4P programs, and "It
just doesn't feel like we're ever going to get a fair share"
because of the high degree of morbidity in the patient population,
statistics are going to compare pretty shabbily," especially
with specialties such as internal medicine, says Boudreaux.
Other specialties, such as orthopedics or critical care,
are likewise badly suited to P4P, notes Boudreaux. "It's
disastrous. We do a lot with people with brain hemorrhages,"
she notes. "They're either going got stay a while or
they're going to die."