Pay-for-performance has become one of healthcare's new catch phrases. It's the future, but it's already here.
Once the province of a handful of innovative insurers, the notion of tying pay to performanceâ€”providing incentives for quality care and preferred outcomesâ€”has swept the country in recent years, with more than 100 different plans of all shapes and sizes now in operation.
More importantly, the feds have embraced the concept with considerable enthusiasm, a development that is sure to have dramatic implications on the way providers receive future reimbursements. The CMS has already launched two initiatives involving hospitals and three for physicians or doctors' groups.
While the government gets in the game, pri
Doctors are notoriously independent and self-reliant, but more of them seem to be seeking strength in numbers. These days, they're finding solaceâ€”along with some financial securityâ€”in big medical groups.
The trend may not signal the end of the solo practitioner or small group practice, both of which still represent the preponderance of physicians in the U.S. But a combination of economic, clinical and lifestyle issues all have contributed to the growing importance and allure of large medical groups.
Medical groups are defined by the American Medical Association as legal organizations that include three or more physicians. In the past quarter-century, the proportion of physicians in group practices has increased from about 20% of all active doctors to slightly more than 30%. In 2005, according to the AMA, about 40% of
"Most healthcare today is still rendered by solo practitioners or small groups," Fisher says. "That's the way it is now, but it doesn't mean that's the future. That's going to change because large medical groups can deliver safety, quality and efficiency. It's all about team delivery and coordinated care."
proportion to grow quickly in the next decade.
Donald Fisher, president and chief executive officer of the American Medical Group Association, a trade group representing most of the large medical associations in the nation, expects that
of these groups had 100 or more doctors, but they represented almost 32% of the 247,000 physicians in group practices.
Group model for physicians practice positions. Conversely, only about 1.4% groups represent only about 11% of all group-While a healthy percentage of the total, these these groups had three or four physicians. 30
vate groups such as the Integrated Healthcare Association and Bridges to Excellence are busy expanding their own incentive-based programs. The 4ˆ½-year-old California Pay for Performance Program sponsored by the IHA includes 225 physician groups employing about half of the state's physicians. Last year, insurers allied with the IHA paid about $54 million in bonuses to physicians.
In February, Bridges to Excellence expanded its own program by teaming on a pay-for-performance initiative with the American Board of Internal Medicine, which represents about 180,000 internists.
Meanwhile, four doctors' groups representing primary-care practitioners have launched a pilot program aimed at these specialties.