Internist Pay-for-Performance Program to Bring Rewards

A major physician certification board and a large healthcare purchasing coalition are collaborating on what they are calling the most comprehensive medical quality measurement program to date.

Under the plan, announced Monday, up to 180,000 U.S. internists would be able report actual clinical performance data directly to the Bridges to Excellence (BTE) quality-improvement program as a means of keeping up certification by the American Board of Internal Medicine (ABIM) and earning pay-for-performance reimbursement bonuses, organizers say.

Called the Comprehensive Care Practice Improvement Model, the ABIM program goes beyond earlier quality-incentive measurement efforts in primary care by tracking care across multiple disease states. "It's a new chapter in an existing program," says BTE Secretary François de Brantes, program leader for healthcare initiatives at General Electric Co.

Bridges to Excellence is a not-for-profit collaboration among health plans, large employers, and healthcare benchmarking services to reward providers for delivering high-quality, patient-centered care. Up to now, BTE has focused on individual disease states such as diabetes and congestive heart failure. The expanded program measures 60 clinical processes and outcomes to look at patients' full health status, taking into account that many people have multiple chronic conditions.

"If you just measure one condition like diabetes, it can give a very distorted view of a practice," according to Christine Cassel, M.D., ABIM president and chief executive.

De Brantes adds, "This gives us something that is comprehensive in looking at internal medicine." He says that BTE had been on a two-year search for a partner to measure cross-disease performance before the internist board signed on.

Now, BTE will be able to recommend physicians who can treat all chronic illnesses a patient might have. "These really could be the stewards of your care," says de Brantes.

The board will be collecting summaries of internist performance for BTE directly from clinical data. "This is going to look at measures you cannot get from claims data," de Brantes says.

While the American Medical Association and some specialty societies have expressed concerns about the data-reporting requirements of pay-for-performance, the ABIM is a certification board, not a political or membership organization. When the Comprehensive Care Practice Improvement Model is fully operational by late 2006, internists will be able to apply quality measurement to maintaining their certification, as well as earn continuing medical education credits and qualify for bonus payments.

Physicians can earn higher performance scores by using electronic medical records, de Brantes says.

BTE has not finalized its rewards schedule for high-performing physicians, but, according to de Brantes, "It will be pretty high. We want to encourage it."
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