News in brief - Jan. 30, 2006

Study: More buzz than action on pay-for-performance programs - Group revises quality standards

Study: More buzz than action on pay-for-performance programs

An examination of 12 nationally representative communities reveals that there's more discussion about pay-for-performance programs than actual plans in place, according to a report by the Washington, D.C.-based Center for Studying Health System Change issued in December 2005. Only two of the communities studied -- Orange County, Calif., and Boston -- have significant programs in place that reward physicians for improving their performance on quality or efficiency measures.

The three largest physician groups in Orange County received "substantial sums" in a late 2004 payout as part of California's Integrated Healthcare Assn. pay-for-performance initiative, with some groups receiving quality-based bonuses of $5,000 to $10,000, the report said.

Boston's program, by contrast, targets efficiency. Health plan contracts tended to withhold about 10% of reimbursement that was later awarded to those who met targets, physicians told researchers.

Physicians in the other 10 communities, which don't have pay-for-performance programs in place, were hostile to the idea, believing that bonus payments would come out of base reimbursement levels and mean a lot of extra work for a minimal financial reward. The Center for Studying Health System Change is principally funded by the Robert Wood Johnson Foundation.

Some studies have shown that P4P programs are growing. According to health care infomatics firm Med-Vantage Inc. there were 107 programs in 2005, up from just 84 programs in 2004.

Group revises quality standards

URAC, a nonprofit organization that promotes health care quality through accreditation and certification programs, recently rolled out revisions to its clinical accreditation standards, including new requirements for ongoing safety initiatives.

The changes affect accreditation programs in areas such as health utilization management, workers' compensation utilization management, case management, disease management and credentialing.

Other changes include standardizing terminology and definitions for URAC's clinical standards modules.