Notes on the news:
* From the "It's About Time" file comes this development from Washington: HHS Inspector General Janet Rehnquist tells drugmakers to shape up their relationships with doctors and purchasers, including group purchasing organizations and pharmacy benefits managers, or risk triggering federal antikickback statutes.
The pharmaceutical companies' showering of gifts on physicians is a national scandal that is finally getting the attention of the industry, the public and government officials. Even the American Medical Association has gotten belatedly into the act with an educational campaign on inappropriate gifts. In typical AMA fashion, the effort has been underwritten in large part by drug companies. No irony there.
GPOs have garnered their own bad publicity lately for sweetheart arrangements that raise the specter of impropriety. Some scrutiny from the Senate Judiciary Committee's antitrust subcommittee seems to have concentrated their minds wonderfully on the problem.
History shows that self-policing in any industry rarely deters the determined wrongdoers. You need a strong dose of law enforcement to clear up serious infections. Witness Enron and all the other corporate scandals of the past year. Let's see if the healthcare industry has the intelligence and integrity to stop the abuses and if Rehnquist has the fortitude to follow through on her threat.
* On the other hand, maybe the drug companies have taught government and industry something useful about behavioral conditioning through positive financial reinforcement.
For example, officials at the Centers for Medicare and Medicaid Services announced the agency will conduct a three-year demonstration project through which physician groups can earn bonuses for controlling costs through quality improvement and better management of patients. That word came after the disclosure in this magazine that the CMS was in talks with Premier to link reimbursement to quality of care.
"Private companies have seen that care can improve more after they create incentives, and we want to test that concept in Medicare," said CMS Administrator Thomas Scully.
And speaking of the private sector, Blue Cross of California announced it will pay bonuses to physicians who earn high marks on a quality score card with 16 clinical measures, including breast cancer screening, childhood immunizations and management of chronic conditions such as asthma and diabetes. This is an expansion of an effort launched earlier this year by a consortium of California health plans.
As we have said repeatedly on this page, poor quality and medical errors constitute a national scandal that was left to fester for too many years. Kudos to the government and insurers for trying to cure the ill.
But these programs prompt an unsettling thought: Physicians may have to be bribed to do the right thing. One would wish that doctors would embrace quality initiatives to help their patients and comply with professional ethics.
The medical director of a large insurance company once said that one of his most discouraging revelations was how easily physicians would change their behavior when money incentives were altered. If these quality programs are successful, we may have more reasons to share in his lament.
In the meantime, maybe the drug companies could take the money they spend on inducements to prescribe and shift it into quality-improvement rewards. Structured properly, that's a form of bribery even Janet Rehnquist might endorse.