Pay-for-performance programs may puzzle you. If so, try these answers to frequently asked questions. They're from Bruce Bagley, M.D., the Academy's medical director of quality improvement.
Q. What does pay-for-performance mean?
A. Pay-for-performance programs offer you payment for doing certain things, meeting certain measures. Do you have a patient registry? It might be worth some money to you. Having a registry is a structural measure. Do you use your registry to coordinate care, to call patients and ask them to come in for the care they need? Doing that is a process measure. Do you keep track of the hemoglobin A1c level of your patients with diabetes? Reaching a certain average A1c is an outcome measure. Most P4P programs combine or blend structural, process and outcome measures and offer incentives -- financial reward -- for meeting the measures.
Q. Are all P4P programs the same?
A. No. They're fairly market-specific. For example, General Electric uses the program called Bridges to Excellence for physicians caring for GE employees; the Bridges program will be different from others. However, if Medicare adopts a P4P program, it will probably be fairly consistent across the country.
Q. Will P4P make me or my staff do chart review?
A. No. This is one of the greatest worries family physicians have expressed to me. Retrospective chart review -- sending a team of nurses with checklists to review charts for the last two years -- is a dumb idea. It costs a lot. You run into problems with documentation and definitions, not to mention legibility. Instead, P4P uses prospective data collection. You and your staff collect data at the time of care. This gives everyone the same definition of the measure (it's on a checklist) and it makes everybody more likely to do everything the patient needs on that day. This system causes quality improvement at the same time as it records data. In fact, the data become a byproduct of the process of care.
Q. Does the Academy have anything to help me see what P4P might be like?
A. Yes. METRIC -- Measuring, Evaluating and Translating Research Into Care -- lets you earn 20 Prescribed CME credits in your office as you complete performance measurement and improvement projects. Modules on diabetes and coronary artery disease are available. We use performance measures from evidence-based guidelines, the same measures the AMA Physician Consortium for Performance Improvement uses. We've had members working with the consortium for several years and want as much consistency in this whole P4P process as we can get. Through METRIC, you can learn how to set up a registry, make office changes and care for groups of patients with similar problems. We picked the topics of diabetes and CAD for the first modules because so many family physicians treat patients with diabetes and CAD.
