Physician Pay Will Soon Depend on Outcomes

Cheryl Clark, for HealthLeaders Media , June 13, 2013

How do you develop measures for every specialty and subspecialty out there? That's a tough one.

I called Ted Mazer, MD, an otolaryngologist in San Diego and former president of the San Diego County Medical Society. No pun intended, but I got an earful.

"We're all eager to find guidelines that work, outcome measures that help patient care and cost-efficiency. But until they're ready for prime time, they're being used as economic squeezes," he says. "The government, the academies, the health plans are all trying to do it. But until these measures are ready, they should not be put to use as an economic vice on physician practice."

Realistically, in his specialty, he says, one could measure symptoms experienced by patients after ENT surgery, and there are good measures for chronic sinusitis. "Sinusitis is being heavily monitored right now to see if too much surgery is being done."

But Mazer, like several physicians I've spoken with, fears that if doctors are forced to document even more, they will spend less time on patient care.

"That's one of the things that's frustrating the hell out of physicians and causing them to talk about getting out of the practice," he says.

I know one thing for sure. The next few months of federal rule making will be very, very interesting.

CMS 2013 Physician Quality Reporting System (PQRS) Claims/Registry Measure Specifications Manual by HLMedit

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1 comments on "Physician Pay Will Soon Depend on Outcomes"

Arun K. Potdar (6/14/2013 at 6:35 PM)
Very informative article. However I feel one important aspect of patients' apathy to follow physicians' orders and instructions need to be address in more details. The the presence of Insurers is also a contributory factor. patients often have to choose between affordability of care and do what is prescribed. This is true for young adults and elderly who are not duel qualified for being slightly over the Medicaid threshold or having small assets valued beyond allowable Dollars. If one remains in traditional Medicare plan he or she has to have a supplemental insurance plan which AARP's brochure shows about $260 per month. Anyone receiving per month, $1400 or more in So. Security can't afford so much and if one goes into Managed Care plan (Medicare Advantage) then the premiums are low but the cost of diagnostic procedures is shifted onto patient at the rate of 51 or more percent. I personally know individual who did not go to get Diagnostic Radiology to check out a persistent but not very painful abdominal area because Aetna HMO 's Evidence of Coverage booklet indicated diagnostic radiology other than X-ray has a co-pay equal to percentage of cost. When he called the member services he was told that the $$ will be determined by the type of test ordered and MRI or CT scan is a specialized radiology and it would cost about $225 in co-pay. I managed radiology and I know Medicare approved charges are going to be around $450 or more so Aetna is making full %600 to $700. The patient has not gone to take that test and three four weeks are gone bye. What a Physician to do with this? Insurance companies are the primary cause of waste, greed and indifference to quality of care. Under the protection of CMS, Advantage Plans are protected from the State Insurance Regulations then what a patient or physician going to do if the outcome is not what the Quality Indexes indicate and he lands up in the Hospital or worst Cancer Treatment Center? I am studying all facets of initiatives under ACA but I do not believe this will work until the basic hindrances like access to specialists and financial deterrent to obtaining care are not resolved. I hope you will discuss this in your next article. Thanks for a well written and informative paper.




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