Pay for Performance: What’s Next?

Like it or not, AAO–HNS leaders are meeting P4P’s challenge with a task force first convened in June to define appropriate metrics for the specialty. Amy Chen, MD, MPH, Assistant Professor of Otolaryngology–Head and Neck Surgery at Emory University School of Medicine and a task force member, says that each of about 12 to 15 subspecialty groups submitted evidence-based outcome measures for the Academy’s consideration at a September meeting. “We will then look at these 24 or so recommendations and pick two to submit to the Academy as possible P4P guidelines,” says Dr. Chen. Then again, head and neck surgeons and pediatric and allergy subspecialists may propose their own metrics.

As the P4P juggernaut proceeds apace, Dr. Roberson hopes that it is implemented gradually so that payers give physicians sufficient time to adapt. “Give people time to measure accurately and to fix their problems,” he says. He also suggests a sliding scale if physicians miss absolute numeric targets by minuscule amounts, a result of random variation. Withholding incentives because of wobbly statistics could unnecessarily penalize physicians. Ultimately, P4P is a physician’s judgment call. If, for example, Medicare automatically deducts 2% from its reimbursement schedule for physicians unable or unwilling to document their quality measures electronically, physicians will have to decide if compliance is worth it.

—David Roberson, MD

Questions Physicians Should Ask about P4P

• What external sources will be used to standardize data collection?
• How can we secure funds for adopting the necessary IT for an electronic medical record?
• What are the right mix and types of incentives for physician performance?
• How should an individual physician be held accountable for the chosen metric?

“We will look at these 24 or so recommendations and pick two to submit to the Academy as possible P4P guidelines.”—Amy Chen, MD, MPH

Notes

1. Bodenheimer T, May J, et al. Can money buy quality? Physician response to pay for performance. Center for Health System Change No. 102, December 2005.
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2. Hospitals must overcome physician resistance before P4P can take root. Health Care Strategic Mgt 2006;24(7):1–4.
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3. Cognetti D, Reiter D. Editorial commentary: The implications of “pay-for-performance” reimbursement for otolargyngology–head and neck surgery. Otolaryngology–Head and Neck Surgery 2006;134:1036–42.
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©2006 The Triological Society