‘Pay for performance’ may become a reality in Medicare

SNOWBIRD, Utah — A “pay for performance” proposal for Medicare that was recently submitted to Congress will affect the practices of ophthalmologists in several ways if it is implemented, said an American Academy of Ophthalmology spokesman speaking here.

William L. Rich III, MD, described some of the features of the Medicare Payment Advisory Commission’s recent report to Congress here at the American Glaucoma Society meeting.

The pay-for-performance proposal for Medicare mimics some programs that are already in place in private health care insurance, Dr. Rich said. Some insurers are using bonus payments to encourage the use of evidence-based measures, he said. The goal is to curb the costs associated with major chronic diseases such as obesity, diabetes and asthma.

As there is no additional funding proposed for the pay-for-performance mandate, the cost to move the health care system toward evidence-based medicine will likely fall on the physician, Dr. Rich said. He said medical specialty groups must devise their own performance measurements and demonstrate that traditional treatment patterns have been and continue to be successful. Specialty societies are to submit proposals to the American Medical Association, which is involved in developing the criteria to be used in the pay-for-performance system, Dr. Rich added.

The report also recommended that Medicare implement electronic medical records, e-prescribing, cost-profiling and patient satisfaction surveys, Dr. Rich said. Private insurers have been the primary advocates of adopting electronic medical record databasing, but there is little evidence of its benefits, he said.