A Medical Device Daily
Pay-for-performance (P4P) is gradually taking root in a number of health systems across the U.S., and a recent article in the American Journal of Managed Care shows that while speed bumps are plenty, P4P is taken seriously by health plans. The article also makes clear that despite the seemingly lumbering pace of adoption at the Centers for Medicare & Medicaid Services (CMS; Baltimore), the private sector is forging ahead.
The authors, Trude, Au and Christianson, designed a study to look at “planning, development and implementation of pay-for-performance programs . . . at the community level. It was a fifth round of site visits conducted in the first half of 2005.
The team interviewed health plan executives employed by 35 plans serving a dozen communities and discovered that while many healthplans are rolling out P4P programs, they demonstrate “substantial design variation within and across markets.” These designs are said to reflect “local conditions that include information technology capabilities, data availability, relative leverage of healthplans and providers, willingness of providers to participate, and employer influence.”
The authors noted that during the 2003 review, providers had rolled out plans in seven of the 12 communities, but that at least one provider now is using P4P in each of the 12 test communities. These include Boston; Miami; Cleveland; Seattle; Lansing, Michigan; and Little Rock, Arkansas. They described the plans in Boston as sophisticated, reflecting “previous experience in hospital and physician contracting.” The P4P plans use one or more of three measurement strategies: performance compared with peers; absolute performance targets; and improvement in performance.
The authors noted that “the amount of money that health plans put at stake…range from nominal amounts to substantial sums,” but some of the executives they interviewed were of the opinion that “plans must tie in at least 10% of provider compensation to performance to change physician practices.”
The degree of customization of P4P plans seems to present opportunities and tripwires. Trude, et al point out that local conditions can influence the way P4P is deployed, but development of a national consensus may be more than difficult if only because “many plans seek a competitive advantage” with their P4P programs. While Medicare is still often seen in some quarters as the 800-lb. gorilla of P4P, the paper notes that “our finding suggest that additional CMS leadership is probably not needed to convince the private sector to pursue” P4P.
AMA taking its case to voters
Election years often highlight the leverage that various elements of society have with each other, and this year is no different. In response to the impending reductions to the Medicare Part B physician fee schedule, doctors are threatening to take their case to the voting public.
A cadre of physicians appeared at a press conference Wednesday with Cecil Wilson, chairman of the American Medical Association (AMA; Washington) to announce their opposition to those cuts and to the prospect that Congress will not take this issue up until after the elections.
Speaking for AMA members, Wilson stated: “[w]e believe its critical that it happen before the election.”
Lab-coat-clad doctors are expected to descend on Capitol Hill offices to press for speedy action because they need to plan their budgets for next year and do not want to wait until the last minute to find out how much Medicare cuts might affect their revenue streams.
Bill Thomas (R-California), the chair of the House Ways and Means Committee, has offered a rewrite of a stalled estate tax cut bill that would include language to block the Medicare cuts, but whether Democrats would be willing to make such a bargain is up in the air.
AMA has indicated that it is prepared to act should Congress fail to deal promptly with the Medicare cuts, threatening to roll out an ad campaign designed to convey a message to voters that “time is running out.” The association has allocated roughly $1.5 million for the campaign, which may appear in nationally distributed publications such as Newsweek and U.S. News & World Report.
The Military Officers Association of America (Alexandria, Virginia) also chimed in at the press briefing, with Steve Stobridge, the association's director of government relations, framing the issue as one that could affect national security. Pointing out that Tricare's physician payments are pegged to Medicare payment rates, he said that the cuts would create recruiting and retention problems because military personnel are already having difficulty getting appointments with doctors who accept Tricare.
NCI selects repositories for genome project
The National Cancer Institute (NCI) and the National Human Genome Research Institute (NHGRI), announced Wednesday that they have selected the first three cancers they will investigate as part of The Cancer Genome Atlas (TCGA) project. The three cancers are those of the ovaries, the lungs, and the most common of brain tumors, the glioblastoma. The three were selected partly because large tissue banks already exist for them and are said to account for more than 210,000 cases of cancer each year.
Acting NCI Director John E. Niederhuber, MD, said that the long-term goal of the atlas “is to delve more deeply into the genetic origins…in order to enable the discovery and development of a new generation of therapies, diagnostics, and preventive strategies for all cancers.” He added that results from the project may enable medical science to “detect cancer early, in its most treatable stage, and provide new targets for the development of specific therapies.”
TCGA was launched in December 2005 as a feasibility study to test whether researchers could use large-scale genomic analysis to track genetic changes that are involved in cancer. The three-year pilot recruited tissue banks based on adherence to standards for ethics, technological sophistication, bioinformatics standards and several others. At present, the facilities are the M.D. Anderson Cancer Center (Houston) for glioblastomas, Children's Hospital of the Ohio State University (Columbus) for ovarian cancers, and Brigham and Women's Hospital (Boston) for lung cancers.