CareFirst BlueCross BlueShield launched yesterday a program to pay doctors as much as $20,000 to install electronic patient records systems designed to reduce medical errors and allow for more precise tracking of the care patients receive.
With the program, CareFirst joins a growing "pay-for-performance" movement in which insurers and employers seek to provide incentives for doctors to provide better care.
A number of other participants in the recordkeeping bonus plan were also announced yesterday, potentially covering 2 million patients in 10 states.
The national efforts are growing but are beginning to generate resistance from doctors who complain that some of the programs aren't designed in a fair way.
CareFirst's announcement yesterday was also part of the health insurer's response to criticism from regulators and lawmakers who say it isn't doing enough to meet its obligations as a nonprofit.
To meet the criticism, CareFirst has already committed to moderating premium increases, cutting its earnings by $60 million this year. The Bridges to Excellence program to improve recordkeeping entails CareFirst spending $800,000 this year and $3.6 million over three years.
Bridges to Excellence is a two-year-old effort involving employers, insurers, the federal Centers for Medicare and Medicaid Services (CMS), the American Heart Association, the American Diabetes Association, and the National Committee for Quality Assurance (NCQA).
NCQA, which accredits health maintenance organizations and other health plans, has so far certified 2,600 doctors for bonuses in its three target areas, said Brian Schilling, a spokesman for the committee.
Three programs
Bridges to Excellence has programs in diabetes and heart care, but CareFirst chose to join one focusing on medical records.
Dr. Jon Shematek, CareFirst's medical director for quality improvement, said the insurer wanted a quality improvement program. CareFirst wanted a program that would use national standards and provide an independent measurement of whether physicians are meeting the standards.
The Bridges to Excellence program develops the national standards, and NCQA reviews physician performance to determine who qualifies for the bonus. Those who meet standards will get $50 for each CareFirst patient they treat, up to $20,000.
"We did a very careful look at the scientific literature," Shematek said, "and there's a growing consensus that there needs to be a fundamental change in the way physician offices are set up to deliver care."
Dr. Barbara G. Cook, president of Johns Hopkins Community Physicians, a group of 115 doctors in 15 locations, almost all in primary care, said doctors such as pediatricians and family practitioners recognize that a good electronic patient record system reduces errors.
For example, she said, such a system could flag whether a patient is allergic to a medication the doctor has prescribed.
It would allow doctors to spend more time with their patients, rather than shuffling through paper medical files, she said.
However, she said, a good system costs about $30,000 per doctor, and "that's a huge, huge expense for a primary-care group to take on."
The rewards from CareFirst can make it work financially, she said. Her eight-doctor group at Wyman Park Health System expects to spend about $240,000 to install a patient-record system and stands to recover $100,000 from CareFirst in bonuses.
Starting point
Dr. William F. Jessee, president and chief executive officer of the Medical Group Management Association, a national professional organization for managers of physician practices, said electronic records are a logical place to start pay-for-performance efforts.
Without an easily managed database, he said, it's impossible to collect more direct measurements of care, such as whether diabetes patients are given needed examinations.
Schilling, of the National Committee for Quality Assurance, said Bridges to Excellence has found that its oldest and largest program - giving doctors bonuses for appropriate diabetes care - has produced good clinical results.
In 2003, 46 percent of the patients managed by doctors who had won bonuses showed good control of blood sugar in a test called hemoglobin A1c, compared with 25 percent of the patients four years earlier.
That means savings of 10 percent to 15 percent in care costs, as patients require fewer hospitalizations and other costly treatments, Schilling said.
Jessee said it makes sense to reward physicians for keeping patients healthy. Otherwise, he said, while the insurer saves money, doctors will lose revenue if their patients stay healthier.
Other areas
Cook said the Hopkins group would be happy to be in a program that rewarded clinical measurements such as screenings and inoculations, as well as the one it is joining on medical records.
But she doesn't think it is fair, she said, to base payments to doctors on measures of outcomes that might be beyond the doctor's control, such as whether the patient's blood sugar level has dropped.
"We can be checking those hemoglobin A1cs," she said, "and they can still be chowing down at the fast-food place."
Copyright © 2005, The Baltimore Sun
|
