A handful of medical groups that represent primary-care practitioners will launch a pay-for-performance pilot program -- one of a growing number of such initiatives sponsored by doctors' associations across the country.
The three-year pilot program, spearheaded by the American Board of Medical Specialties Research and Education Foundation, includes the American Academy of Family Physicians, American Academy of Pediatrics, American Board of Family Medicine and American Board of Internal Medicine. Called "Improving Performance in Practice," the effort includes about 100 physicians in Colorado and North Carolina who will receive support in improving their practices, gathering data on outcomes and reporting performance measures on conditions such as diabetes and asthma.
"This is the first time all these physician-led organizations have come together to pool resources and knowledge to assist practices in improving efficiency and care," said Sheldon Horowitz, executive director of the board's foundation, which has received funding for the program from the Robert Wood Johnson Foundation.
The pilot program is the latest in a string of similar initiatives by doctors across the country who are increasingly eager to cash in on pay-for-performance programs, which provide financial incentives that can amount to as much as 10% of total income. More than 100 pay-for-performance plans are now in operation, sponsored by a wide variety of organizations, including private groups, insurers and the federal government.
In February, the ABIM, which represents about 180,000 internists and ranks as the largest medical-specialty board, partnered with Bridges to Excellence to create a pay-for-performance plan that could provide cash incentives to tens of thousands of doctors (Feb. 13, p. 14). Working with the not-for-profit coalition, the medical-specialty board is now selecting quality measures and setting payment levels for the plan, which is expected to kick off later this year.
Michele Johnson, a Washington-based government-affairs representative with the Medical Group Management Association, which is deeply involved in the long-range planning of pay-for-performance initiatives, said these efforts are the culmination of several years of spadework by doctors' groups. "It may seem like these things are all happening at once, but medical-specialty societies have been working quite diligently for years to develop programs like these. You're seeing the fruition of a great deal of work."
The American Medical Association, which has about 245,000 members and is the nation's biggest doctors' organization, also weighed in on pay-for-performance several months ago, striking a deal with key federal lawmakers on a pay-for-performance program to cover most of the nation's 885,000 physicians (Feb. 27, p. 7). That agreement, which includes the development of about 140 quality measures covering 34 clinical areas, is expected to be rolled out sometime in early 2007.
But the deal was blasted by many doctors, including the Alliance of Specialty Medicine, which represents 13 medical-specialty societies with a total of more than 200,000 physicians. Critics of the AMA's deal said the plan is far too complicated and that it was brokered in secret without comment from the specialty societies, which said any agreement about a federal program of this type should have included assurances that doctors will actually receive payment for voluntary participation.
Horowitz said the increasing number of pay-for-performance programs, including those sponsored by doctor-run groups, is more complementary than competitive, providing the opportunity to develop national standards that will "help us get to the promised land -- high-quality care for all patients -- faster."
"There are a couple major (doctors') organizations developing these," he said. "So there will be some standards that everyone uses to bring order as new measures emerge. The goal is to improve physician performance and patient outcome."
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