Extra pay for quality care not easy money

One program finds the devil is in the details when it comes to starting a performance-based bonus program for physicians.

By Mike Norbut, AMNews staff. July 21, 2003.

For six months, physicians have been working to satisfy requirements outlined in the nation's most ambitious attempt to offer bonuses for quality care. But they've done so without really knowing what they'll be paid for their efforts.

Doctors involved with the Integrated Health Assn.'s "Pay for Performance" plan in California got tired of being in the dark. So the California Assn. of Physician Groups organized a meeting July 8 to pressure some of the state's largest health plans to disclose their payment formulas. Referring to health plans, Don Crane, the group's president and CEO, said: "If you don't schedule a final exam, they won't study."

The meeting apparently had the desired effect, as only one insurer declined the invitation, and other plans like Aetna revealed payment formulas.

But the slowly emerging details of the plan, which will rate and award bonuses to the state's largest medical groups based on clinical measures, patient satisfaction and use of technology, underscores the practical difficulties of putting such a far-reaching initiative into practice.

Problems with organizing the participants and the hesitation of some HMOs to announce their payment plans have made the initiative, one of a nascent movement of quality-bonus programs across the country, more difficult to implement than expected.

"There's a lot of anxiety at the medical group level," said Beau Carter, IHA's executive director. "They don't know all the specifics about the money, and it's making them nervous. Some are just angry. They think it will be a waste of time."