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Doctors worry about P4P popularity

Physician practices see the rise of pay-for-performance plans on the horizon - and they're beginning to worry about the implications.

While many are intrigued about the prospects for receiving higher payments, there's concern about how such plans will be administered and whether initial investments will provide enough of a payback.

Approximately 100 pay-for-performance approaches are in operation around the country, said Lyle Berkowitz in a recent presentation at the 2006 Cerner Health Conference in Orlando, Fla.

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The big challenge for pay-for-performance programs, said Berkowitz, of the Northwestern Memorial Physician Group in Chicago, is not to lose sight of the big picture - achieving change in the incentives of healthcare delivery.

 "We want to shift from rewarding the 'good apples' to achieving system redesign," he said.

Pay-for-performance is still a new concept; early models pay providers rewards for reporting on what steps they're taking to meet care criteria, like administering antibiotics to patients presenting with suspected pneumonia.

There are benefits to that, Berkowitz said.

"What gets measured gets noticed," he said. "Reporting alone makes a difference to physicians and hospitals."

Still, as programs evolve, they'll encounter many barriers, such as the use of standards, data collection and reporting and increasing the number of patients covered under such plans, which affects return on investment.

One of the biggest philosophical concerns is that physicians who do a better job adhering to evidence-based measures that improve patient health will experience fewer patient encounters. Doctors who are primarily paid under fee-for-service methodologies will receive less money, and rewards under pay-for-performance may not make up their income losses.

"The big question is who should get paid?" Berkowitz said. "Providers may eventually push back and demand a share of the savings that payers experience."

Poorly designed pay-for-performance programs may not do much more than make physicians more adept at playing the game, he said.

"If we just focus on meeting some criteria, the provider may do whatever he needs to do to look good and get their money," he said. "It may not help the system overall."