IT used to measure quality of physician's performance

As more health care organizations move to pay physicians based on meeting certain quality standards, IT is playing a bigger role in aggregating the data used to measure care.

Some organizations are using the financial incentives from these "pay for performance" programs to justify the investment in costly IT upgrades, according to speakers Sunday at the Healthcare Information and Management Systems Society's annual conference.

David Brailer, the national coordinator for health information technology, described pay-for-performance programs and IT as "first cousins," that increasingly are intersecting as health care providers grapple with ways to fund electronic health records (EHR). Some studies have shown that physician practices that heavily invest in IT have 30 percent better patient outcomes than those without the technology, he said.

Some physicians struggling to justify the expense of EHRs are looking at pay-for-performance programs as a way to offset some of the hefty costs, which can be tens of thousands of dollars annually per physician. In California, for example, a pay-for-performance program operated by the Integrated Healthcare Association (IHA) last year paid out US$90 million to physicians who met quality standards. The IHA, which is a nonprofit collaborative of physicians, health care systems and health plans, has inspired significant efforts among the 225 participating physician groups to collect relevant data, said Ronald Bangasser, director of external affairs at Beaver Medical Group in Redlands, Calif., which participates in the IHA's incentives program.

"We're starting to see the improvements, and that's what got the physicians to buy into the idea," Bangasser said. "Now people are talking about quality. If the physician thinks it's a good measurement, and you put money behind it, you'll get change more quickly."

Beaver Medical last year received $1.2 million in payments from the IHA, half of which went to participating doctors, while the other half was invested in IT, he said. However, the group didn't qualify for an additional $400,000 because of a drop in patient satisfaction. The group quickly hired a consultant to help raise those scores, he added.

Christiana Care Health Services, a health care system based in Wilmington, Del., is running a pilot project to aggregate and compare its data on patient medication history with information from Blue Cross and Blue Shield of Delaware. The results of the project have shown that 50 percent of the time, the insurer had more detailed information about a patient's history -- especially related to filling prescriptions -- than the health group, said Edward Ewen, director of clinical information at Christiana.

Cigna Corp. is measuring how the doctors with whom it contracts meet certain criteria for quality, but it has opted to reward its members with lower co-payments if they use doctors who meet the standards, rather than providing the physicians with financial rewards, said J. Paul Oates, vice president of medical management systems at Philadelphia-based based Cigna.

"Our employers are insisting that we measure performance," he said. "The only way the health care system is going to change is to motivate the consumer."

Cigna currently measures 19 categories of specialist physicians. This year, the company will add primary care physicians and additional specialists, Oates added.

Still, pay for performance can't be the sole factor driving the adoption of EHRs, Brailer said, noting that smaller practices may be at a disadvantage.

Pay for performance and health information technology have got to be ubiquitous," Brailer said. "It's not as if we can make pay for performance bite-sized. If you don't have enough people to manage the process of care... it is hard to improve it."

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