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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

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

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

Patients 2003 2004 2005 2006

Used asthma medications 71% 74% 76% 91%

Kept blood pressure <140/90 57% 60% 64% 68%

Used depression medications 49% 51% 49% 42%

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

Met diabetes 2 (tighter targets) NA 4% 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
slide7
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
slide8
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