Unless physicians are adequately compensated for the health information technology investments they make to help satisfy future pay-for-performance requirements, they will view pay-for-performance "as another unfunded mandate imposed on their practices with no meaningful rewards in terms of higher reimbursements," according to a report released last week by the American College of Physicians.
In the report, Linking Physician Payments to Quality Care, the ACP also called for a graduated pay-for-performance payment structure that takes into account the complexity and numbers of measures being reported, the time and expense of documenting performance, and the level of health IT purchased to support approved quality-improvement programs.
In addition, the report stated that, since larger medical practices have built-in economy-of-scale advantages, pay-for-performance programs should help remove some of the obstacles that smaller practices face in terms of IT adoption, implementation and administration. Recommended examples that the report gives of this assistance include financial incentives and technical support.
Citing declining Medicare reimbursements, ACP Vice President of Practice Advocacy and Improvement Michael Barr, M.D., noted that "It's a difficult environment for physicians -- who are essentially small businesses -- to make that initial investment" in IT.
While studies have shown that physicians in small practices have been slow to jump on the IT bandwagon, Barr said that he believes there are a significant number of doctors who are sitting on the sidelines "waiting for the right time of their choosing" to switch from paper-based to electronic practices. He explained that these physicians are waiting for standards to be harmonized on electronic medical records and other risk-lowering factors to take effect.
Barr said internists and other primary-care physicians recognize the value in being able to do online checks of their patients' laboratory tests, radiology images and prescriptions from other doctors, but he added that the financial benefits accrued by better coordination of care do not necessarily return to the physicians who helped develop this coordination by investing in IT.
Near-term costs, long-term savings
Another complicating factor, Barr noted, was that using IT to help coordinate preventive treatments that are currently underused may turn out to be more expensive in the short term but should save money down the road. "I can't say 'You'll save X amount of money' -- though some people have tried to do that," he said.
The ACP report described current physician payments systems as flawed and unable to sustain quality-improvement incentives. It stated that physicians should be fairly compensated for their work and expenses, and that payment should be updated to reflect inflation. It added that reimbursement should be based on "patient-centered, physician-guided care" using evidence-based clinical measures -- and not on volume and episodes of acute illness.
"Benefits don't really come back to the practice itself, but savings should flow back to the person who helped create that savings," Barr said. "Those who invest, those who innovate, should get reimbursed accordingly."
Barr added that health IT can be used not only to create new payment systems, but also to redesign small medical practices.
A chance to restructure
"The goal is to not just 'pave the cow path' and end up doing the same meandering things we're doing now -- only faster," Barr said, explaining how EMRs should be used to create a patient-centric healthcare system that breaks down medical silos and provides better coordination of care through the use of registries and other electronic tools.
He said that the ACP is hoping to provide real-life models of what a medical practice within this system would look like. Last month, the ACP received a two-year $996,000 grant from the Physicians' Foundation for Health Systems Excellence that will be used to create the Center for Practice Innovation.
At this center, the ACP will test innovative approaches in practice management, physician education, patient safety and disease management. Measuring the success of these programs will include evaluating patient, physician and staff satisfaction.
David Brailer, M.D., HHS' national coordinator for health information technology, has praised the ACP for its leadership in promoting EMRs among its almost 120,000 members. But Barr borrowed a term used by a different federal official to describe his organizations position on IT adoption.
"The attitude we have is that electronic medical records or electronic health records -- whatever the name du jour is," Barr said, "is 'rationally exuberant,' to borrow a (Federal Reserve Board Chairman Alan) Greenspan phrase."
Read the report: http://www.acponline.org/hpp/link_pay.pdf.