The number of pay-for-performance programs has practically quadrupled in the last five years, according to a report released last week, andin the past few weeksit appears that the number of related items in the news has proliferated by a similar percentage.
Even as payers issue glowing news releases about the expansion of their programs' scope and the millions of dollars in physician rewards they're dispersing, government officials, research organizations and physicians are questioning the motivation and methodology of current pay-for-performance programs. In the end, the one industry segment that may truly be happy with pay-for-performance programs are health IT vendors who can persuade providers that their electronic systems are absolutely necessary for the data management that require such programs.
The data, from healthcare informatics group Med-Vantage and the Leapfrog Group, projected there will be 155 pay-for-performance programs in place this year, compared with only 39 in 2003. A report that came out two weeks ago and may hold long-term significance came from PricewaterhouseCoopers. The report looked at 10 different pay-for-performance programs and found that, together, they used almost 60 different physician-performance indicators, no one indicator was used by all 10 programs, and no two programs rewarded providers the same way.
Pay-for-performance programs can be an important tool to link payment to quality, the PWC report stated, "But the wide variation in program structures, performance metrics and rewards structures mutes their potential impact."
"I thought the report by PWC was pretty much on the money," said Francois de Brantes, national coordinator for the Bridges to Excellence physician-reward program. "Most of the employers and the plans we work with are increasingly cognizant of the fact that this dispersion of attention just creates a lot of noise, and that we need to strengthen the signal by having very clear standardized measures used by multiple plans and employers in a single community."
Bridges to Excellence made news last week by announcing it now has more than 100 employers and health plans working in 19 regions participating in its physician office, diabetes-, cardiac- and spine-care programs.
"Physicians have to know 'If I do this, I'll get a positive hit from multiple parties,' " de Brantes said. "To be effective, P4P needs very clear criteria and performance thresholds: You get to this level of performance, you get a bonus. And not just from Plan A, but from Plan B, Plan C and from others that are also participating."
While mostly in use on the East Coast, Aetna announced in May that it would use Bridges to Excellence standards for pay-for-performance programs in Washington state.
Meanwhile, the physician-ranking programs under consideration for use by insurers Aetna, Cigna HealthCare and UnitedHealth Group have come under scrutiny by New York State Attorney General Andrew Cuomo, who expressed concern that the rankings may be used to steer patients toward less-expensive rather than higher quality providers.
In an e-mail, Aetna spokeswoman Cynthia Michener said Aetna is fully cooperating with the request for information, is committed to transparency and is reaching out to medical societies to address physician concerns about reliable data.