Physician Pay Will Soon Depend on Outcomes

Cheryl Clark, for HealthLeaders Media , June 13, 2013

The Centers for Medicare & Medicaid Services is seeking feedback from doctors as it builds a model for reimbursing physicians based on actual outcomes rather than process measures.

The e-mail to physicians earlier this month wasn't unexpected. It comes around this time each year when the Centers for Medicare & Medicaid Services invites doctors to tell Uncle Sam how they should be paid.

This time, though, the phrasing of the "Call for Measures" request was different, and from many doctors around the country, I'm sensing a worried cringe.

That's because this time, under authority of the Patient Protection and Affordable Care Act and several ensuing regulations, the payer in chief will move from measuring processes of care to measuring actual outcomes to determine the size of physicians' checks.

"CMS is seeking a quality set of measures that are outcome-based rather than clinical process measures [that] fall into one of the National Quality Strategy (NQS) priorities domains where there are known measure and performance gaps." the agency's message reads in part.

See Also: MGMA: Physician Compensation Increasingly Based on Quality Measures

The deadline for submittals is July 1. CMS will mull them over and in a few months, issue new outcome measures and rules for the Physician Quality Reporting System, adding to or replacing some of the current 328 measures, which largely are processes of care.

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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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