Reduce Risk of Medical Errors, Improve Care with P4P

The mere mention of the phrase pay-for-performance leaves some folks in health care circles shaking their heads in frustration, but Robert Fortini, clinical operations manager at Community Care Physicians in Albany, N.Y., has a different take on the topic.

"When we hear CMS is doing demonstration projects on quality, we're very interested in participating" said Fortini. "I'm constantly fishing for P4P programs of various kinds."

The multispecialty group practice Fortini oversees has 35 individual practices and 191 clinicians -- many of them FPs -- practicing in the Capital District of upstate New York.

Fortini and the physicians at Community Care embrace P4P programs because they translate into better patient care. "It's been pretty well demonstrated over the last 10 years that quality and improvement strategies result in decreased cost and improved patient outcomes," said Fortini.

"The bottom line is that reducing the risk of medical errors -- and these are just strategies to do that -- is the right thing to do,” said Fortini. The Bridges to Excellence coalition approached Fortini about participating in its P4P program, and his decision to accept the challenge has reaped rewards.

"Right now I have eight practices -- 43 physicians -- that have realized the maximum reward potential for the first year," said Fortini, adding that everyone agreed to put the money against the bottom line to offset the cost of either implementing or maintaining EHR systems in their practices. "Our goal is to have all of our sites recognized within the next year. The sequence of applications will follow our EHR rollout," he said.

The physicians are paid up to $50 per qualifying patient per year for three years based on the degree of compliance with National Committee for Quality Assurance standards, which are used to measure practices. The money is paid out in one lump sum at a predetermined time as established by the BTE coalition.

The time and effort expended at the front end (setting up registries, collecting data and reporting data) is balanced by the fact that in the end, participating clinicians not only realize monetary payoffs but also quality improvement in their practices, said Fortini. "That money can be used to support electronic systems that further facilitate quality care and efficient practice."

"We're not only satisfied with the financial reward and accreditation status, but certain systems and best practices have been spread throughout the organization," said Fortini, The end result is improved patient outcomes in preventive care and chronic disease care.