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Thursday, September 21st 2006

Distinguished Institute Report Draws Scorn From Lowly Medical Student

“I Am Interested In Long Distance Savings Pay For Performance, Very Interested.”

Despite the title, not scorn but mixed feelings on a new IOM report (executive summary) saying cut Medicare reimbursements (!) and use the savings to fund pay for performance. Here’s the wire piece,

The institute said Congress should cut the base payments that Medicare makes to hospitals, nursing homes, insurers and doctors. Then, it should use the savings to create pools that reward providers when they do work that has been proven effective in improving a patient’s health, it said.

Is This The Fabled Meeting Place of the Board on Health Care Services?

It is hard to argue with such a distinguished body…so, above, I’ve resorted to the only reasonable tactic. Certainly many in the healthcare industry aren’t going to lavish this IOM report with praise,

“If hospitals are already losing money treating Medicare patients, there’s no incentive if you’re going to further cut payments,” said Carmela Coyle, senior vice president for policy at the American Hospital Association. “What’s needed is a stable source of funding for these kinds of incentives. It shouldn’t be done by cutting what are already inadequate reimbursement amounts.”

But I suppose that is the IOM’s function – to draw ‘unbiased’ conclusions, and to make the difficult reccomendations (because God knows the AHA isn’t going to advocate for cutting hospital reimbursement).

I defintley support pay for performance and certainly continuing to throw money at the healthcare system is NOT the solution. Still, cutting physician reimbursement to fund P4P is not the answer either. There is plenty in the way of other costs and inefficiency that needs to be addressed before we start cutting physician payments.

The NEJM website has a podcast on the new IOM study with Karen Davis (Ugh – This Commonwealth Fund “grade” for the U.S. healthcare system is garbage) and Elliot Fisher.

Does She Really Say, “If You Do A Good Job Communicating With Your Patients…”?

Many physicians weren’t exactly high on P4P for other reasons, the idea general reimbursement is to be cut to fund P4P is not going to go over well. I think we can find measures of quality which can be standardized, but clearly the president of the Commonwealth Fund is off her rocker a little bit in this podcast.

One of her measures of quality is communicate well with patients. And that data comes from what? Patient reported surveys? That is an impossible task trying to standardize a measure like that (and I hear P4P opponents shouting, “That’s what we’ve been saying all along!”) And really, if those are the kind’ve suggestions coming out of the IOM then how are we suppose to take their call to cut Medicare payments in order to fund this sorta program seriously?

It should be noted (as you can imagine) ONLY ONE member of the Board on Health Care Services, who prepared the report, holds a private position – CMO of the Palo Alto Medical Foundation. MORE THAN HALF of the members are academics. Maybe that ivory tower jab isn’t so far off base.