1. Government P4P Programs: Pay for Performance - Is Medicare a Good Candidate? Albert W. Morris, Jr., M.D. President National Medical Association The Second National Pay for Performance Summit Beverly Hilton Hotel, Beverly Hills, CA February 15, 2007

2. Health Disparities Overview Blacks lead the nation in 12 of the top 15 leading causes of death. Black infant mortality is 2.5 times higher than that of white babies. White men outlive black men by 7 years; and white women outlive black women by 5 years There are 85,000 to 130,000 excess deaths among blacks each year.

3. IOM, 2002 Unequal Treatment Disparities in healthcare… Are remarkably consistent across 10-year corpus of literature Occur in every investigated disease area Persist even after accounting for insurance, severity of disease, and patient compliance Result in higher mortality for minority patients

4. AHRQ National Healthcare Disparities Report 2006 Racial disparities in healthcare quality exist… Across all key measurements of healthcare quality, including effectiveness, patient safety, timeliness, and patient centeredness Across all levels of care, including preventive care, acute care, and chronic disease management Across all healthcare settings, including primary and dental care, emergency departments, hospitals, & nursing homes

5. Utilization & Compliance Minorities are more likely than whites to… Avoid care Delay seeking care Not comply with care

6. Physician Practice Patterns Minority doctors are more likely to serve minority populations. Patients tend to rate their physicians communication style higher in race- concordant relationships. Minority patients report higher levels of healthcare satisfaction when receiving care from minority physicians.

7. Key IOM Recommendations DHHS should… Implement P4P in Medicare using a phased approach. Implement a monitoring and evaluation system. Assist providers with data collection and reporting.

8. NMA Task Force Recommendations (1 of 2) Quality measures must be delineated from cost containment measures. All measures must be culturally relevant and stratified to the patient population. Reimbursement formulas must be appropriate for the patient populations served. Capacity-building support must be provided to small and disadvantaged providers. Ensure ample input from a diverse array of physicians and patients.

9. NMA Task Force Recommendations (2 of 2) Provide physician and patient education. Evaluate impact on solo and small practices. Focus on clinical data over claims data. Repeal the Sustainable Growth Rate framework. Use a voluntary and phased approach in the early stages.

10. QUALITY Doing the right thing regardless of who the patient is…and regardless of whos looking.