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Report Cards & Reputational Incentives  Incentive to “volunteer” –0.4 – 2.0% CMS payments –Basically, a hospital’s profit margin  Currently, 95% of hospitals.

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Presentation on theme: "Report Cards & Reputational Incentives  Incentive to “volunteer” –0.4 – 2.0% CMS payments –Basically, a hospital’s profit margin  Currently, 95% of hospitals."— Presentation transcript:

1 Report Cards & Reputational Incentives  Incentive to “volunteer” –0.4 – 2.0% CMS payments –Basically, a hospital’s profit margin  Currently, 95% of hospitals now volunteer data on –21 quality metrics –260 for hospital enrolled in the Premier Hospital Quality Incentive Demonstration Project Berry M Straube. Towards a value-based Model: Pay for Reporting/Performance Initiatives in the Medicare Program. June 7, 2007; www.ehcca.com/presentations/pfpaudio20070607/straube.ppt (28 Nov 2008); Deloitte: Paying for Performance (2006); Image URI on request.

2 Report Cards & Reputational Incentives  What is CMS going to do with the data? Publish it HospitalCABG CostG6 Control SM $17,870 100% OP $19,305 73% KU $24,625 100% Hospitalcompare.gov 29 Dec 08

3 Report Cards & Reputational Incentives  Do patient comparison shop for healthcare? –Yes, if the pt is  Young  College Educated –No,  Hospitalcompare.gov gets 2.5 M hits/month  Only 15 % of employers review provider-specific data  Avg patient researches a surgeon < 1h Meredith B Rosenthal, Bruce E Landon, Sharon-Lise T Normand, et al.: Employers’ Use of Value-Based Purchasing Strategies. JAMA 2007; 298(19):2281-88. Graham J: Government posts hospital death rates. Chi Trib, Aug 20, 2008 (internet edition); David H. Howard and Bruce Kaplan: Do Report Cards Influence Hospital Choice? The Case of Kidney Transplantation. Inquiry. 2006; 43(2): 150–159. http://www.comparisonshopping.us/comparison-400.gif; Pauline W Chen: Do Patients Trust Doctors too Much? NY Times Dec 18, 2008 (internet edition); Meredith B Rosenthal, Bruce E Landon, Sharon-Lise T Normand, et al.: Employers’ Use of Value-Based Purchasing Strategies. JAMA 2007; 298(19):2281-88.

4 Report Cards & Reputational Incentives  But (there is always a but) such figures overlook: –Un- and under insured / Medical tourists –HSA/HDMI –Private insurers http://hayleymorgan.com/blog/wp-content/uploads/2008/08/butt-blog.jpg

5 Report Cards & Reputational Incentives  The future: PHQIDP  hospitals now compete for $$$ –Good: Top decile gets 2% bonus; second decile gets 1% bonus –Bad: Bottom decile gets 2% of DRG reimbursement. –Ugly: Shame? Berry M Straube. Towards a value-based Model: Pay for Reporting/Performance Initiatives in the Medicare Program. June 7, 2007; www.ehcca.com/presentations/pfpaudio20070607/straube.ppt (28 Nov 2008) http://www.parisetudiant.com/images/29-26good-bad-ugly-characters2.jpg

6 Report Cards & Reputational Incentives  PQRI –Tax Relief and Health Care Act of 2006. P.L. 109-432 – Analogous process to HQI –“Voluntary” performance measurement reporting began 2007 see also "Medicare Improvements for Patients and Providers Act of 2008" (H.R. 6331); Medicare, Medicaid and SCHIP Extention Act of 2007, Pub. Law 110- 173; Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) (Pub. L. 110-275) http://www.rootsweb.ancestry.com/~ohrichla/HealthDeptPhotos/9039.jpg

7 Report Cards & Reputational Incentives  Incentive to “volunteer” in 2009 –2.0% CMS payments –Alone this may not get MD’s attention –Satisfactory reporting requires:  Reporting on 3 or more of 119 performance measures  For 80% of practice CMS: Physician Quality Reporting Initiative; http://www.cms.hhs.gov/pqri/ (09 Jan 09); Deloitte: Paying for Performance (2006); URL avalible on request; Deloitte: Paying for Performance (2006); URL avalible on request; http://makemoney357.com/uploaded_images/How-Kids-Can-Make-Money-755494.JPG

8 Report Cards & Reputational Incentives  Physiciancompare.gov –Seems imminent –Officially: No definitive plans –2010 CMS can publish “who” has contributed –2011 effective date? Russell TR: My Perspective. Bulletin of the Am Coll Surg 2008; 93(6): 4-6. http://www.worstdoctors.com/common/imagelib/index.htm/1424_300_181_crop_267db.jpg

9 Report Cards & Reputational Incentives  Not unreasonable to think that PQRI will result in –fewer MDs in the market –A penumbra of fear –Those MDs that remain in the market will be more compliant TR McLean, Will reputational incentives stimulate a reversal of the physician brain drain. J Health Serv Res Policy 2008; 13(1): 50-2.; http://bloggingabout.net/UserFiles/Erwyn%20van%20der%20Meer/Image/SolarEclipse.jpg

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