Is pay-for-performance slowing down, or set to take off?
That question was up for debate at the third annual Pay for Performance Summit this past week at the Beverly Hilton in Beverly Hills, Calif.
Foremost on some participants minds seemed to be how to improve on todays payment measures and move them into widespread practice, all the while building on incremental gains made over the past five to eight years.
Oh, and whens the best time to slip away and catch a few rays by the magnificent pool in this lovely, sunny, 80-degree, palm-swaying weather?
The turnout of some 700 attendeesabout the same as last yearwas seen as a great success by Tom Williams, executive director of the Oakland, Calif.-based Integrated Healthcare Association, the conference sponsor, especially considering the competition.
In another sunny venue across the countryOrlando, Fla.the Healthcare Information and Management System Societys monster conference was happening all week, with 28,400 attendees.
A fair number of attendees in Los Angeles said they were at HIMSS earlier in the week, enjoying sunny skies on both coastslucky devils.
Health IT was a hot topic here, tooand some said it is the best hope for moving pay-for-performance to the next level, or keeping it alive, depending on whom you ask. Whats needed, many agreed, is better data and better collaboration that can come with the aid of electronic records.
Peter Lee, executive director of national health policy for the Pacific Business Group on Health, called good data the elephant of performance measurement. He wasnt being political. Public reporting of performance information will drive improvements. The starting point is giving that information to providers.
To get to standardized and detailed data, electronic health records are a critical component, said Carolyn Clancy, director of the Agency for Healthcare Research and Quality.
Enthusiasm for pay-for-performance may be dying down, Clancy cautioned. Although weve been seeing steady improvements over the past five years, the rate of change is slowing, she said. At the same time, the cost of healthcare continues to rise.
Tom Priselac, president and chief executive officer of 914-bed Cedars-Sinai Medical Center in Los Angeles, had some stern words for his colleagues on the matter. Too many healthcare leaders are focused on their own individual interests instead of the overall public good, he said. We need to look beyond our own institutions to what will benefit the overall public.
Success in payment reform, he said, will require unprecedented levels of collaboration across the entire system of care. Hospitals and physicians have a substantial obligation to knock down barriers to improving quality and effectiveness.
Mistrust of pay-for-performance among physicians is a huge barrier, said Nancy Nielsen, president-elect of the American Medical Association. Im not trying to be confrontational, she told the crowd before being just that. But we need to stop trying to manage each other. Performance is a demeaning term.
Nielsen ticked through a litany of evolving physician attitudes on pay-for-performance. One example:
Old view: Pay-for-performance is an evil health plan plot.
New view: Pay-for-performance is an evil government and health-plan plot.
A lively debate on whether pay-for-performance is actually working to improve efficiencies and outcomes seemed to end in a draw. Richard Norling, president and CEO of the Premier hospital alliance, said it is working, and how, adding that theres huge untapped potential for more hospital measures. (Of course, Premier has a vested interest in the topic, running the huge hospital pay-for-performance demonstration project for CMS.) For instance, he said hed like to see hospital rewards for lowering 30-day readmissions of patients who have undergone coronary artery bypass surgery.
Donald Palmisano, president of Intrepid Resources and a former AMA president, however, said that patients should be given the tools to make their own healthcare decisions, and negotiate rates with hospitals and other providers. (This drew audible gasps of scorn from some audience members.) The patient is not stupid, he said.
Francois de Brantes, CEO of Bridges to Excellence, made it clear that mistrust runs both ways. We need something better than, Trust me, Im doing a good job, he said.
The buzz of the conference was New York Attorney General Andrew Cuomos recent settlements with most major insurers over their physician-ranking programs, which requires third-party oversight, and how that would play out over time. It is critical that physicians and hospitals be at the table when they are creating these standards, Lee told the audience.
And there seemed to be great interest, judging by panel attendance, on just what the heck health plans across the country are doing with available data and how they are rewarding physicians and hospitals today.
Dennis OLeary, president emeritus of the Joint Commission, said that paying physicians and hospitals to improve performance most certainly isnt dead yet. I see the pay-for-performance mechanism were working with now as a way station to someplace else and someplace better, he said optimistically.
Getting there is going to take hard work, de Brantes agreed. This notion that somehow performance information on quality just materializes out of thin air so patients can make decisions on it is fantasy.
The trick is not only getting that data but applying it in a meaningful way. Our current payment system is incredibly perverse, Clancy quipped. But there are many other ways to do it wrong.