Pay for performance
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Pay for Performance. Macaran Baird, MD, MS Professor and Head University of Minnesota Department of Family Medicine and Community Health University of Minnesota Medical Center Family Medicine Residency Program / Smiley’s Clinic.

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Pay for Performance

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Pay for performance

Pay for Performance

Macaran Baird, MD, MS

Professor and Head

University of Minnesota

Department of Family Medicine and Community Health

University of Minnesota Medical Center Family Medicine Residency Program / Smiley’s Clinic


Pay for performance

State of Minnesota is adopting P4P to direct care to top performing clinics.


Mn dept of employee relations

MN Dept. of Employee Relations

  • Started P4P with 4 tiers of performance

  • Applies to all state employees

  • Increased co-pays for clinics with decreased performance


Data problem will exist for sometime

Data problem will exist for sometime

  • Some systems use billing data that can be inaccurate

  • Chart audits are often flawed and expensive

  • Works best if based upon patient registries


Chronic disease management results

Chronic-Disease-Management Results

Patients2003200420052006

Used asthma medications71%74%76%91%

Kept blood pressure <140/9057%60%64%68%

Used depression medications49%51%49%42%

Met diabetes 1 (looser targets)12%12%16%20%

Met diabetes 2 (tighter targets)NA4%6%9%

MN Community Measurement Project


Top scoring clinics

Top Scoring Clinics

  • Adult asthma treatment

    • Lakeview Clinic: 99% ages 5-56 were enrolled and had appropriate medications

  • Cancer screening combo

    • HealthPartners Medical Group: 65% ages 50-80 were up to date on all appropriate cancer screenings

  • High blood pressure

    • Mayo clinic: 86% ages 46-85 with high blood pressure had it under control


Pay for performance

  • Childhood vaccinations

    • Mayo Clinic: 95% ages 2 and under received vaccinations

  • Chlamydia screening

    • United Family Practice Health Center: 62% of sexually active women ages 16-25 had a test for chlamydia


Pay for performance

  • Diabetes care

    • Camden Physicians and Winona Clinic: 23% with diabetes ages 18-75 achieved 5 treatment goals

  • Depression treatment

    • Sioux Valley Clinic: 63% ages 18+ diagnosed with new depression episode were treated with antidepressants and had 3 follow-ups


Medicare quality pilot program planned

Medicare quality pilot program planned

  • 3-year demonstration to compensate physicians for care to patients with chronic conditions

  • Physicians must be in small or medium practices and provide care to 50 Medicare patients

  • They will submit data annually on 26 quality measures

  • 1st year: “pay for reporting” to establish baseline measures

  • Subsequent years: practices earn $ based on performance on quality measures


Iom urges medicare to adopt pay for performance

IOM urges Medicare to adopt pay for performance

  • Institute of Medicine released a report in 9/06 recommending a pay-for-performance system

  • Current system of fee for service encourages volume rather than efficiency and quality

  • Congress should reduce base Medicare payments and use money saved to fund P4P

  • Report acknowledges fewer than 20 studies about P4P which came to differing conclusions about its effectiveness


For department of family medicine and community health

For Department of Family Medicine and Community Health

  • Next $500,000 in income from practice can arrive via P4P or adding 5,000 visits!

  • Therefore, we’re learning to reach P4P targets, clarifying our data, and improving care


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