Monday, November 10, 2008

Health Train Reports

Pay for Performance:  It's a no way street, since medicare has failed to live up to it 's promise.  Providers are struggling to determine what went wrong...Not a win-win situation, and a loser for both sides.  The experiment to improve outcomes by requiring coding for certain behavior on the part of providers and rewarding them for the same is flawed fundamentally by a rigid set of parameters to measure, which in the long run will most likely evolve with time.  It's going to be the dog chasing it's own tail.   Most providers do not have the time or resources for this unless it is a substantial size group.  2 percent  incentives for hiring administrators and software to perform this function is offset by increased overhead.  This amounts to negative reinforcement if payers and CMS decide to penalize those who do not conform to a very questionable mandate.

The effects of medical group practice and physician payment methods on costs of care.

AMA survey results:This study indicates that payment methods at both the medical group practice and physician levels influence the cost of care.  However, the methods by which that influence is manifest is not clear.

Many doctors are still trying to figure out what went wrong with the 2007 PQRI.

Confidential physician feedback reports from last year's initiative, which for the first time offered Medicare bonuses for successfully reporting quality measures, became available to participating practices starting in August. Since then, many participants have been struggling to make sense of the information that they received -- if they were able to access it at all.  Only about 20% of 408 physicians surveyed in September by the American Medical Association were able to download their 2007 feedback reports, which told each doctor whether he or she reported enough measures to qualify for a bonus. Nearly 60% of those who sought assistance from the Centers for Medicare & Medicaid Services in accessing the confidential reports said they received little to no help from the agency.

In the interest of efficiency CMS has contracted with new companies to process payments.

Never you mind that the new companies are unable to perform.

How will CMS deal with increasing complexity of coding, transition to ICD 10, and vendors who are ill prepared to assume the responsibility for payments to providers?

And how will CMS deal with audits and repayments by providers?

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