Apr 17, 2009 | Laboratory News, Laboratory Pathology
Bundled Payment Demonstration Project Changes How Labs Would Be Paid
Efforts in the nation’s capital to reform healthcare are still in the formative stage as the new President and the new Congress consider various approaches. Meanwhile, the Centers for Medicare & Medicaid Services (CMS) started the new year by launching pilots for a bundled-service payment scheme. Not only may this be the beginning of the end of the fee-for-service payment system, but it has important implications for clinical laboratories and anatomic pathology groups.
The bundled payment system demonstration projects are a first step to what’s coming next. The Medicare Payment Advisory Commission, better known as MedPAC , released its blueprint for reforming the delivery system to Congress on March 17 in its annual Report to the Congress: Medicare Payment Policy.
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Dec 29, 2006 | Laboratory News, Laboratory Pathology
When the NCQA reported significant improvements in healthcare last September, an Associated Press article on this topic was picked up by Yahoo News, CBS, Fox and many other news sources across the country. It was likely so widely reprinted because it was a rare piece of good news: The quality of the health care provided to millions of Americans improved last year across several dozen categories!
It is first evidence that efforts to improve patient safety and encourage providers to follow recommended health guidelines have made a difference. The laboratory industry has been front and center in this trend. For example, early in this decade payers began asking laboratories to report Health Plan Employer Data and Information Set or HEDIS-required measures such as Pap testing, Pap results, HbA1c testing, HbA1c results, among others. Improved use of laboratory testing as a result of HEDIS requirements has contributed to improved outcomes in several areas of the American healthcare system.
NCQA stated that, for patients covered by private insurance plans, there were significant improvements in 36 of 42 categories measured by HEDIS data sets. Improvements were noted in immunization rates among insured children, cervical cancer screening, colorectal cancer screening, and the controlling of high blood pressure in hypertension patients. While each of these areas may have only improved by a few percentage points last year, over a 10-year period, improvements are highly visible. For example, last year 96% of heart attack patients were given drugs to lower their blood pressure and slow heart rate to prevent a second attack. A decade ago, only 62% of patients suffering heart attacks were given those medications.
According to Margaret E. O’Kane, the president of the National Committee for Quality Assurance, “This past decade has demonstrated the benefits of measurement, reporting, and accountability, but three out of four people don’t enjoy those benefits today.” In fact, only 1 in 4 Americans are enrolled in a health plan that collects and reports data on the quality of care. O’Kane urges us to start asking why.
As Dark Daily reported in recent months, pay-for-performance programs are being instituted by the Medicare program and insurance companies across the US. The time is fast approaching when these programs and quality of care measurements for physicians, hospitals, and laboratories will become the norm. As the media gives greater exposure to the benefits of measuring quality of care, laboratories can be certain that they will see increased accountability and reporting on their quality by insurance companies.
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Oct 18, 2006 | Laboratory Management and Operations, Laboratory Pathology
We wanted to make sure to report on the success of the pay-for-performance program in Britain and give it adequate space in Dark Daily and it’s full due. However, we also wanted to note, in this separate piece, that the success of the program in Britain may be slightly exaggerated.
In the study Pay for-Performance Programs in Family Practices in the United Kingdom, targets were met for 83% of eligible patients and practices earned nearly 97% of possible points available. The National Health Service (NHS) anticipated that practitioners would earn only 75%. Why did so many practitioners perform so well? There are a couple of plausible explanations.
First, the targets for high performance may have been too easy for practitioners to achieve. Trial and error is the only effective way for the NHS to find out how ambitious the targets should be. To address the possible problem of targets being set too low, the NHS has altered the 2006-2007 scheme so that all minimum and some maximum payment thresholds have been raised, 30 indicators have been dropped or modified, and 18 new indicators have been introduced.
The second reason that so many practitioners did an exceptional job of meeting targets is that there may have been some misreporting by practitioners. Certain patients may have been omitted from documentation to make it easier to meet targets. To ensure that misreporting is more difficult to get away with, the NHS has established Primary Care Trusts. These Trusts are statutory bodies responsible for the delivery of health care in local areas. They will inspect local practices and perform audits and inspections both randomly and at practices suspected of incorrect or fraudulent returns.
It is highly likely that the pay-for-performance program in the US will have similar results with practitioners performing better than expected in its first year. Doctors, hospitals, and laboratories who pay attention to developing targets from The Centers for Medicare and Medicaid and who make incremental improvements in their practices and facilities before the US adopts a pay-for-performance program in 2007 will put themselves in an excellent position early success. These health care practitioners and facilities will ensure not only that they meet appropriate standards and provide patients with the best possible care, but also that they will reap the maximum benefits and incentives from the government for their meeting targets.
Oct 16, 2006 | Laboratory Management and Operations, Laboratory Pathology
Pay-for-Performance programs are not limited to the United States. In 2004, the National Health Service (NHS) of the United Kingdom introduced a pay-for-performance program for family practitioners with much acclaim. A study called Pay for-Performance Programs in Family Practices in the United Kingdom published in the New England Journal of Medicine in July of this year reported findings on the success of the program in its first year.
The National Health Service in the UK committed £1.8 billion ($3.2 billion) in additional funding over a period of three years for the pay-for-performance program for family practitioners. The program would increase practitioners’ income by up to 25%. Incentives were based on practitioners’ performance with respect to 146 indicators covering clinical care for 10 chronic diseases, organization of care, and patient experiences.
It was reported that in the first year of the new pay-for-performance program, 95.5% of practices scored highly, earning them an average of £76,200 ($133,200) each. The pay-for-performance program increased the gross income of the average family practitioner by £23,000 ($40,200), but this was partially offset by the fact that practitioners were responsible for both the nursing and the administrative costs of meeting the targets.
It cannot be denied that the UK pay-for-performance program improved quality of patient care in its first year. Doctors in the UK were awarded a significant bonus and could justify the cost of improving their practices with equipment, training, and additional staff to achieve high quality scores. Unfortunately, this may not be the case with Medicare and Medicaid pay-for-performance programs in the United States.
Federal legislation directed the pay-for-performance model to be adopted in the U.S. by mid-2006. The Centers for Medicare and Medicaid (CMS) will then begin rewarding high-performing doctors, hospitals, health plans, and other providers. Unfortunately, according to another study in the New England Journal of Medicine – Paying for Performance in the United States and Abroad – the U.S. budget will only allow for bonuses of 1 to 2%, while the United Kingdom was able to provide 5 to 10%. These smaller bonuses might not be enough incentive for US physicians to meet high performance standards because the cost of upgrading their practices may eat up the entire bonus.
Already the number of pay-for-performance programs offered by private payers is increasing each year. As grades and rewards are directed to doctors based on their performance, it increases the likelihood is high that they will select labs based on reputation and quality. Furthermore, the CMS may adopt pay-for-performance programs for laboratories that provide them with incentives based on their turnaround time, the accuracy of their results, and other performance factors. Laboratories should be tracking the pay-for-performance trend to understand what indicators are likely to be used to evaluate and reward clinical labs.
