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Issue Date: February 2007

Pay for Performance Raises Questions
A federal pay for performance demonstration project is helping to improve the quality of care in hospitals, says the federal Centers for Medicare & Medicaid Services. In a report last month, CMS says it made incentive payments totaling $8.69 million to 115 top-performing hospitals (about $75,569 per hospital). The participating hospitals reported improvements in process and outcome measures in their treatment of patients with acute myocardial infarction, heart failure, coronary artery bypass graft surgery, pneumonia, and hip and knee replacement. Other reports are not quite so glowing. An article in the Feb. 1 New England Journal of Medicine concludes, “Hospitals engaged in both public reporting and pay for performance (P4P) achieved greater improvements in quality than did hospitals engaged only in public reporting. Additional research is required to determine whether different incentives would stimulate more improvement and whether the benefits outweigh the costs.”

Beyond HIPAA: Preventing ID Theft
Patient medical records contain all the information a thief needs to steal someone’s identity. “Medical records and patient charts may include Social Security numbers, driver’s license numbers, phone numbers, addresses, even checking account and credit card information,” says Rhonda Picou, RN, MSN, vice president of physician compliance for Peak Performance Physicians, LLC, in New Orleans. Yet providers are generally more concerned about protecting clinical information than they are about protecting their patients’ identity information. “If someone breaks into a physician’s computer system, you can be sure they care less about a patient’s clinical information and more about the information that could be used to steal identities,” Picou comments. “Clinical data have layers of protection, such as computer passwords and other security features, to prevent leaks, but providers just don’t think about protecting identity information. It’s not a natural thought process for them.”

Make Choices Match Career Goals
Once accustomed to being a full-time physician, many younger doctors face a range of choices about career direction. The challenge for these physicians is selecting an alternative that lays the foundation for a stable, growing, and satisfying professional career. For any physician in practice, there are a wide variety of possible career pathways, but each one has advantages and disadvantages that relate to professional development and lifestyle decision. For physicians who opt to be full-time clinicians, the variety of settings to consider includes joining an existing group, forming a new group, starting a solo practice, or buying into a medical group. A physician seeking to work in other settings can consider taking a position in a hospital or in another country, or working in the public or private sectors.

ACPE Fosters Professional Development
Q: Let’s begin by discussing some of the reasons physicians are motivated to pursue business degrees.
A:Like members of any group, their motivations vary. Physicians in private practice typically want to learn more about the business side of practice. For others, it’s become sort of a baseline career requirement to have an advanced degree, especially in business or medical management. Obviously, earning an additional degree or certification doesn’t guarantee that a physician will automatically advance within an organization or that the degree will be the deciding factor between two candidates for a position. But, from what we’re hearing from recruiters, an advanced degree is becoming a prerequisite in many organizations.
Q:In addition to advancement or additional opportunities, are there other reasons physicians pursue advanced degrees?
A:We’ve found that many doctors are frustrated by the limitations of medical practice. They want to have a more significant effect organizationally on the health care system and realize that they need medical or business management skills and education to do so.

Data Needed When Marketing
Physicians seeking to build their practices need to ensure that they retain the patients they have and add new patients whenever possible. John McDaniel, president and CEO of Peak Performance Physicians, in New Orleans, offers a number of ways physicians can build volume by marketing to the right patients. “It’s not unusual for physicians to ask me how they can develop a marketing plan for their practice,” McDaniel says. “And the answer is, it is relatively simple. “The tools physicians would use include physician referral reports or patient origin information,” McDaniel says. “Also, physicians could use Zip Code analysis data. These are the primary tools a practice would use. But, in addition, it would be best to be aware of the general demographic and socioeconomic information within a marketplace to determine whether it’s growing, how it’s growing, and where and how the group is positioned to take advantage of growth.

Spending Fails to Boost Outcomes
An analysis of Medicare costs and survival gains for heart attack patients shows that increased health care spending in recent years has not been associated with improved outcomes for these patients. Done by Jonathan S. Skinner, PhD, and colleagues at Dartmouth College in Hanover, N.H., the analysis also demonstrates that over time, heart attack survival improvement has slowed while spending has risen unabated.
“The goal of our analysis was to reexamine the conventional wisdom that the escalating costs associated with heart attack care are justified by improvements in clinical outcomes,” says Skinner, Dartmouth’s John French Professor of Economics. A researcher who focuses on health care spending and outcomes, Skinner also serves as professor of community and family medicine at Dartmouth Medical School’s Center for the Evaluative Clinical Sciences. In addition to examining health care spending trends over time, the researchers analyzed geographical variation across 306 distinct regions in the United States to determine whether those areas exhibiting the highest costs also experienced the greatest improvement in outcomes. Published in Health Affairs, Feb. 7, 2006, the analysis is especially interesting in light of contradictory findings regarding the link between higher health care spending and heart attack outcomes, Skinner says. Increasingly, health care payers and purchasers are interested in ensuring that they are paying for the best outcomes. As a result, such research may lead to changes in the financial incentives payers and purchasers offer to providers.

Financial Incentives Gain Momentum
A growing number of health plans and other payers are developing payment incentive systems to improve the quality of medical treatment for patients with diabetes. “The concept of pay for performance in the treatment of diabetes has gained momentum in the past few years,” says Steven B. Leichter, MD, president of Endocrine Consultants, a medical practice in Columbus, Ga. “The concept depends on the basic assumption that specific and reliable outcomes can be identified measuring whether diabetes care is carried out in a competent manner.” As health care costs rise, such efforts have become increasingly important, says Leichter who is co-director of the Columbus Research Foundation and a professor of medicine at Mercer University School of Medicine in Macon, Ga. Diabetes costs the nation $132 billion annually, including $92 billion in direct medical costs and $40 billion in indirect costs, such as lost work days, restricted activity, mortality, and permanent disability, says the American Diabetes Association in Alexandria, Va. The total cost of diabetes will rise to $156 billion by 2010, the ADA says.