Doctors have found a way to get a pay raise from health insurers and keep patients happy at the same time: Practice better medicine.
This year, six of Colorado’s largest physician-practice associations will get bonus checks from Anthem Blue Cross Blue Shield as part of a pilot program tracking how well doctors perform.
Bonuses are based on how well the 1,095 doctors do at things like lowering patients’ blood pressure or controlling their diabetes.
While neither Anthem nor the physicians would disclose the exact bonuses, the payout for five of the medical groups totals $504,120 for 2004 performance, according to Anthem.
The sixth group, Centennial-based MedSouth, chose to take its bonus in the form of an overall pay raise – about 4 percent, said Amy MacMillan, an Anthem project manager.
In the health care industry, financially rewarding doctors for quality care is a new and sharp departure from past reimbursement practices.
Health plans rewarded doctors for delivering the most medicine for the least amount of money, said Dr. Ken Cohen, medical director of Golden-based New West Physicians.
“There was such a backlash,” Cohen said. “Paying for quality is a major stride forward.”
A study in Wednesday’s Journal of the American Medical Association said paying for performance is a growing trend. “Pay-for-performance has significant potential to improve the performance of the health care system,” said Meredith Rosenthal, assistant professor of health economics and policy at Harvard’s School of Public Health and the article’s author.
In 2004, 35 health plans covering 30 million patients offered pay-for-performance programs, according to The American Academy of Family Physicians.
The academy projects that to rise to at least 80 health plans covering 60 million members by 2006.
Medicare, the federal program covering 42 million elderly and disabled, also has a demonstration pay-for-performance pilot underway.
“It was slow getting off the ground,” said Dr. Arthur Klein, chief operating officer of New York Presbyterian Hospital. “I think you are going to see a rapid proliferation.”
Klein co-chairs a task force on pay-for-performance contracting for the National Committee for Quality Health Care.
The JAMA study noted, however, that most programs are still new and unproven.
In 2003, for example, California doctors in a pay-for-performance program sponsored by PacifiCare Health Systems outperformed non-participating physicians in Oregon and Washington by only one measure: cervical cancer screening.
Still, the California physician groups earned bonuses between $360,155 and $436,618, researchers found.
A 2003 study by Med-Vantage, a data company serving major health insurers, found that payments for performance ranged from 1 percent to 40 percent of total annual revenue for 30 medical practices – with an average of a 10 percent bonus.
So far Anthem is the only health plan that offers a true pay-for-performance program in Colorado.
The Denver physician groups working with Anthem chose 10 nationally recognized medical care guidelines by which they would be measured.
Anthem tracked the physicians’ performance by reviewing medical claims and, in some cases, pulling information from patients’ charts.
For every quality measure the physicians met, the doctors were paid extra. If they exceeded the guideline, they got an additional bonus.
In Anthem’s contract, physicians don’t lose any money if they fail to meet the standards.
“It’s created a better relationship with our providers,” Anthem’s MacMillan said.
“They really didn’t believe that we were going to do this and it was all going to be positive, that there was no downside and we weren’t going to ding them,” MacMillan said.
Participation in the program also changed the way doctors delivered care, said physician association directors.
For example, at Denver-based Physicians Health Partners, pediatricians were able to raise the childhood immunization rate from 66 percent to 92 percent, said Dr. Jay Want.
New West Physicians met or exceeded all of its quality benchmarks – such as lowering blood pressure of patients with hypertension.The result, said Ruth Benton, the group’s chief executive: “a really nice bonus.”
The doctors were ultimately motivated more by competition with colleagues and a desire to be the best, than by money, said Want.
“It also was in line with what the physicians, in our guts, wanted to do,” he said.
Staff Writer Marsha Austin can be reached at 303-820-1242 or maustin@denverpost.com
