Provider Incentive System Linking Compensation to Patient Outcome Measure

Article ID: 510288

Released: 10-Mar-2005 12:00 PM EST

Source Newsroom: American Medical Group Association (AMGA)

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Newswise — The American Medical Group Association (AMGA) announced the launch of a quality-based reimbursement initiative, a multi-year endeavor to consider (a) the current, flawed reimbursement model in America's healthcare delivery system, (b) the premises and barriers to designing and implementing a new reimbursement system based upon the delivery of quality care, and (c) the development of strategies that will lead to the implementation of a new reimbursement system. The initiative was announced at AMGA's 2005 Annual Conference, March 10-13 in Los Angeles.

The broader aim of the initiative is to support enhancements in health by developing new incentive systems for practitioners in which a significant portion of compensation is linked to quality measures. America's current payment system for health care is based upon a wrongful philosophy of paying for services rendered without defined regard for the quality of care provided or the measurable outcomes gained by the patient. Said otherwise, Practitioner A and Practitioner B are reimbursed identically for delivering the same services regardless of the differences in the quality of care they delver. From a practical, economic standpoint, until now, little standardization and little rationale existed for measuring quality improvements linked to appropriate levels of financial reimbursement beyond low single-digit percentages.

Additionally, practitioners have been facing reimbursement policies that sought to manipulate utilization behaviors as the primary means for restricting overall healthcare costs rather than using bases of outcomes measures and evidence-based medicine. As a consequence, the quality of care provided under such cost restrictions was considered irrelevant to the financial considerations of reimbursement.

"This time has never been riper for AMGA's initiative," said Donald W. Fisher, Ph.D., CAE, AMGA's President and Chief Executive Officer. "Rather than working piecemeal to patch up Medicare's declining Physician Payment Update, AMGA is starting anew in seeking a new reimbursement system that aligns accountability and transparency with the delivery of quality care and payment. This initiative seeks to totally overhaul the process of reimbursement by linking it directly to attainment of quality performance and outcome measures."

In carrying out this initiative, AMGA will convene a number of work sessions of nationally prominent leaders in medicine, health service research, health economics, and industry to examine the flaws inherent to the current system of healthcare reimbursement; to design an new payment system linking quality care and reimbursement; and to develop strategies by which a new system can be put into play. A Steering Committee of thought leaders in health care will serve to guide and coordinate this initiative. The members of the Steering Committee are:

"¢ Charles Beever, M.B.A., Vice President and Partner, Booz Allen Hamilton"¢ Robert Berenson, M.D., Senior Fellow, Urban Institute"¢ Carolyn Clancy, M.D., Administrator, Agency for Healthcare Research and Quality, DHHS"¢ Jay Crosson, M.D., Executive Director, The Permanente Federation"¢ Alain Enthoven, Ph.D., Marriner S. Eccles Professor of Public and Private Management, Stanford Institute for International Studies"¢ Paul Ginsburg, Ph.D., President, Center for Studying Health Change"¢ Margaret Gunter, Ph.D., President and Executive Director, Lovelace Clinic Foundation"¢ Uwe Reinhardt, Ph.D., James Madison Professor of Political Economy, Woodrow Wilson School of Public and International Affairs, Princeton University"¢ Stephen Shortell, Ph.D., Dean, School of Public Health, University of California at Berkeley"¢ Sean Tunis, M.D., Director, Office of Clinical Standards and Quality, Center for Medicare and Medicaid Services, USDHHS"¢ John Wennberg, M.D., Director, Center for Evaluative Clinical Sciences at Dartmouth, Professor of Community and Family Medicine (Epidemiology) and of Medicine, Dartmouth Medical School"¢ Gail Wilensky, Ph.D., John M. Olin Senior Fellow, Project Hope"¢ Nicholas Wolter, M.D., Chief Executive Officer, Deaconess Billings Clinic

The American Medical Group Association (AMGA) represents medical groups, including some of the nation's largest, most prestigious integrated healthcare delivery systems. AMGA advocates for the multispecialty medical group model of healthcare delivery and for the patients served by medical groups through innovation and information sharing, benchmarking, leadership development, and continuous striving to improve patient care. The members of AMGA deliver health care to more than 50 million patients in 42 states, including 15 million capitated lives. Headquartered in Alexandria, Virginia, AMGA is the strategic partner for medical groups providing a comprehensive package of benefits, including political advocacy, educational and networking programs and publications, benchmarking data services, and financial and operations assistance. For more information, visit http://www.amga.org.


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