Friday, October 10, 20081
Making pay for performance difficult
Medicare is offering bonuses to doctors who adopt e-prescribing. However, the process is convoluted and practices that do everything right still don't receive payment:
Richard McArdle, the CEO of an ophthalmology practice in Portland, Maine, who attended the CMS-sponsored conference, told MedPage Today that his group's experience with PQRI will make it hard to convince his doctors to seek the Medicare bonus for e-prescribing.If you want doctors to adopt an initiative, you have to make the carrot more attractive and easier to obtain.
"We did everything right and we didn't get paid," said McArdle.
Comments
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Marshall Maglothin
OIG Approves Gainsharing Program for Ortho and Spine
Post a CommentAUGUST 14, 2008
The OIG has approved the first orthopedic and spine gainsharing project.
No details have been released on the participating hospitals or the particular procedures and technologies that will be covered in the project. Additionally, no financial terms have been publicized, though the Goodroe press release says that most arrangements allow participating physicians to be paid as much as 50% of the savings generated under the program. According to Goodroe, up to $75 million in potential savings has been identified in the existing programs, so these benefits could be significant. A 2006 survey found that most physicians felt that gainsharing was an effective way to align financial incentives for hospitals and physicians, though they were divided on what constitutes gainsharing and whether it should be disclosed to patients.
In her guest blog for HealthpointCapital, Goodroe Healthcare Solutions founder Joane Goodroe commented, "Gainsharing is first about assuring quality of care for patients and secondly about increasing efficiency." Industry groups such as MDMA and AdvaMed have taken issue with these objectives, suggesting that gainsharing may reduce the quality of patient care, slow development of new technology and discriminate against smaller manufacturers.
The OIG appears to be sensitive to these concerns. Their stance on gainsharing is not necessarily that it's legal, but only that it's not illegal. All existing programs are closely monitored for violations of the Stark (Physician Self-Referral) and Anti-Kickback statutes. Similar safeguards will surely be in place for the new orthopedic and spine programs, which can help to mitigate some worries about compromising patient care.
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I've present Gainsharing to MGMA Annual, BONES, MGMA FMS and MSO Societies.
The docs have to approach the hospital - the hospital is not going to be very aggressive about sharing their savings.
I'm only on the List long enough to post this, please contact me directly with any questions.
mmaglothin@cox.net
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Marshall Maglothin MHA MBA
President, Blue Oak Consulting, LLC
COO, Inpatient Specialists, P.A.
Fairfax, VA / Rockville, MD
5:35 PM