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Pressure builds for 'pay for performance'


Pressure is building in Washington to move forward with the federal government's proposed pay-for-performance Medicare reimbursement program.

In a new report from the prestigious Institute of Medicine (IOM), a special committee has urged establishment of "a comprehensive, universally accepted system ... to measure and report on the performance of healthcare providers and organizations." The panel said Congress should establish a new independent board within the Department of Health and Human Services (HHS) to coordinate development of standardized performance measures and monitor progress toward improving the healthcare system.

"Performance measures are a fundamental building block for all quality improvement initiatives," said committee chair Steven Schroeder, professor of health and healthcare, University of California, San Francisco.

IOM pointed out that many public and private organizations have made substantial progress developing measures for such areas as clinical care, organizational performance and patients' perceptions of care. But there is duplication in some areas and neglect in others, and an equitable, efficient, well-coordinated system is needed.

Funding urged

IOM urged Congress to authorize between $100 million and $200 million each year from the Medicare Trust Fund to be used for the board's activities.

In November 1999, IOM said as many as 98,000 Americans were being killed each year by medical mistakes, and made recommendations it said could slash that rate in half within five years.

Despite a flurry of publicity and activity, including Congressional hearings, increased funding for patient safety research and additional studies and reports, it hasn't happened, according to Lucian Leape, M.D., an adjunct professor at the Harvard School of Public Health and a member of the IOM study committee that produced the latest report.

"The challenge still remains to ramp up efforts on a national scale, to generate stronger institutional leadership, and to spread the culture of quality to all organizations and individuals in the healthcare community, as well as to the policymakers who make decisions and appropriate funding related to healthcare," he wrote in an article published by IOM.

"We didn't get the 50 percent reduction in medical errors within five years that we had hoped for," the article stated. "But we now have a vision in place; we're learning what works; and we're starting to translate more and more plans into actions. With proper leadership, it just may be possible to reach the initial error-reduction goal - and even do better - in the not-so-distant future."

Other developments

Meanwhile, several developments are under way that will affect all physicians, including dermatologists, in 2006.

Last July, Congress approved the Patient Safety and Quality Improvement Act to encourage hospitals and healthcare providers to voluntarily report medical errors, serious adverse events and the underlying causes so their mistakes can be analyzed and prevention methods developed.

In January, the Centers for Medicare and Medicaid (CMS) was scheduled to launch the Physician Voluntary Reporting Program (PVRP) to analyze the quality of care provided to Medicare beneficiaries. Physicians will be asked to use nonspecialty specific "G-codes" within the existing administrative system for claims. (For details, visit PVRP@cms.hhs.gov

The PVRP is part of the Physician Focused Quality Initiative, which also includes the Doctors Office Quality (DOQ) Project, designed to develop and test a comprehensive, integrated approach to measuring the quality of care for chronic disease and preventive services in physicians' offices.

The goals are to provide information for informed decision-making and to support and stimulate adoption of quality improvement strategies by practitioners in doctors' offices. (For more information, visit http:// http://www.cms.hhs.gov/PhysicianFocusedQualInits/05_PFQIDOQ.asp.)

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