Pay for Performance Macaran Baird, MD, MS Professor and Head University of Minnesota Department of Family Medicine and Community Health University of Minnesota Medical Center Family Medicine Residency Program / Smiley’s Clinic

State of Minnesota is adopting P4P to direct care to top performing clinics.

MN Dept. of Employee Relations Started P4P with 4 tiers of performance Applies to all state employees Increased co-pays for clinics with decreased performance

Data problem will exist for sometime Some systems use billing data that can be inaccurate Chart audits are often flawed and expensive Works best if based upon patient registries

Chronic-Disease-Management Results Patients 2003 2004 2005 2006 Used asthma medications 71% 74% 76% 91% Kept blood pressure <140/90 57% 60% 64% 68% Used depression medications 49% 51% 49% 42% Met diabetes 1 (looser targets) 12% 12% 16% 20% Met diabetes 2 (tighter targets) NA 4% 6% 9% MN Community Measurement Project

Top Scoring Clinics Adult asthma treatment Cancer screening combo Lakeview Clinic: 99% ages 5-56 were enrolled and had appropriate medications Cancer screening combo HealthPartners Medical Group: 65% ages 50-80 were up to date on all appropriate cancer screenings High blood pressure Mayo clinic: 86% ages 46-85 with high blood pressure had it under control

Childhood vaccinations Mayo Clinic: 95% ages 2 and under received vaccinations Chlamydia screening United Family Practice Health Center: 62% of sexually active women ages 16-25 had a test for chlamydia

Diabetes care Depression treatment Camden Physicians and Winona Clinic: 23% with diabetes ages 18-75 achieved 5 treatment goals Depression treatment Sioux Valley Clinic: 63% ages 18+ diagnosed with new depression episode were treated with antidepressants and had 3 follow-ups

Medicare quality pilot program planned 3-year demonstration to compensate physicians for care to patients with chronic conditions Physicians must be in small or medium practices and provide care to 50 Medicare patients They will submit data annually on 26 quality measures 1st year: “pay for reporting” to establish baseline measures Subsequent years: practices earn $ based on performance on quality measures

IOM urges Medicare to adopt pay for performance Institute of Medicine released a report in 9/06 recommending a pay-for-performance system Current system of fee for service encourages volume rather than efficiency and quality Congress should reduce base Medicare payments and use money saved to fund P4P Report acknowledges fewer than 20 studies about P4P which came to differing conclusions about its effectiveness

For Department of Family Medicine and Community Health Next $500,000 in income from practice can arrive via P4P or adding 5,000 visits! Therefore, we’re learning to reach P4P targets, clarifying our data, and improving care