An Indianapolis employers' healthcare coalition has prepared a list of 500 physicians it plans to invite to participate in what amounts to a peer-review quality improvement process that could provide pay bonuses to physicians who meet coalition standards of excellence.
"We're not rating physicians, and we're not for public report cards," said Ned Lamkin, M.D., president of the Indiana Employers Quality Health Alliance. "We're going to help the doctors demonstrate their own quality so they can get paid more."
The alliance, a member of the National Business Coalition on Health, includes among its members the Indianapolis-area operations of General Motors, Indiana state government, Herff Jones and six other employers. The alliance has invited about 20 area physician leaders to a meeting April 6 to get their input on the proposal.
"The whole goal is to have this come from the physician community," Lamkin said.
The employers would like to contract directly with providers, he said. One of two initial steps in that direction will be in disease management, finding ways to pay the local physicians involved in patient care instead of distant third parties, Lamkin said.
The other initiative is the pay-for-performance program based on the peer-review quality assessments.
That plan calls for having local physicians perform analysis on 10 to 20 patient cases per physician. The cases will be offered voluntarily by physicians seeking to join the quality initiative.
Lamkin said the rewards would be both on the front end, with higher payments for patient care, and on the back end, with physicians sharing in the savings by employers from lower costs due to higher quality care. Bonus levels are as yet undetermined.
"I think it's got to be substantial enough to make a difference that the physicians will do it, but it's got to be low enough for people to buy it," Lamkin said. "I think the market will tell us what that is, but the first thing is we've got to hear from the physicians."
Naturally, the employers are very interested in back-end cost reductions, but based on physicians' bitter experiences with health plans' accounting on such reimbursement schemes, "the physicians are just terribly leery and I don't blame them," Lamkin said.
Last week, a coalition of 28 employers with staff help from Mercer Human Resource Consulting, announced formation of its Care Focused Purchasing initiative in which they intend to mine patient claims data to issue public report cards on physicians.
But Lamkin said case studies are a better way to go.
"We did not believe you could do an adequate job at the physician level by looking at claims," he said. "We think you have to look at the way they manage patients and you can do that with a reasonably good sampling and have peers do the evaluation.
"You can go in to see the way the physician thinks, how often are they asking the patient to come back, what tests are they ordering or not ordering, are they looking at the pharmacological interventions, were they careful about drug interactions, did they consider drug interactions when the patient presented? It's all of the elements that go into making good clinical decisions.
"If they consistently do things inappropriately, they're not as good a physician as you can hope. And you can make that determination."
Physicians who pass the screenings will be publicly disclosed, probably in a coalition directory, and rewarded, Lamkin said, but those who fail won't be held up for public exposure.
"The good guys be documented for that and get paid for it accordingly, and the guys who don't do so well, they can find out so they can improve."
Lamkin said he'd like to see the program up and running by the end of the year.