Should Doctors Get Bonuses? Should they be rewarded for ‘good work’?

This is a great article from Time (also featured on CNN Headline News) that looks at CMS’s Pay-for-Performance program efforts. The title “Should Doctors Get Bonuses?” prompts many to think, “Don’t they already get paid enough!” Well, what most of us don’t realize is that, according to the Journal of the American College of Surgeons (January 2008), ‘Projections are that payment rates (for physicians) will decrease by an average of 5% each year for at least the next 9 years, resulting in reductions of as much as 40% by 2015.’ (Physician, do you realize this?) So, what do we think? I say, SURE, reward physicians for good performance. Now, the real question will be HOW will they gather correct information and documentation to prove their performance? You’ll find out………through a system such as ComplyMD.

In the article, they point out that,

“Corporate America has long doled out bonuses to employees who do the best work. Such pay-for-performance programs have only recently caught on in the health care industry, but caught on they have — more than half of U.S. health plans, including Medicare, report offering some type of incentive pay to doctors and hospitals for meeting certain basic standards of care…..”

Well stated. If the rest of corporate America is rewarding employees for good work performance, why not do so in healthcare? And, even more so. Physicians are taking care of people everyday, and peoples’ lives are at stake? Would we not want them to be on some sort of incentive program? YES, we all think that ‘ideally’ every physician in America should take the 100% utmost care of their patients. And many of them do. Yet we must remember, physicians are humans and think like most of us as well – they’d like a little financial pat on the back, just like the rest of us in corporate America.

“In the absence of systematic reform, many insurers have turned to pay-for-performance programs to try to improve quality of care, and cut costs along the way. Early efforts have shown positive signs. In the first three years of an ongoing pay-for-performance demonstration project led by the Centers for Medicare and Medicaid…..findings released in January, researchers following the project concluded that quality scores in the five measured clinical areas had improved on average 17%, and costs had been reduced $1,000 per patient on average. Researchers estimated that if all American hospitals adopted similar bonus schemes, we could save 70,000 patient lives per year and $4.5 billion in hospital costs annually.”

So this data proves that P4P can work. Well, how can we attempt to save 70,000 patient lives per year and $4.5 billion in hospital costs annually in American hospitals? Yes, through P4P initiatives. But HOW will they gather more information to prove their performance rates are up? The issue is documentation: PHYSICIANS MUST PROVIDE PROPER DOCUMENTATION IN ORDER TO DOCUMENT THEIR GOOD PERFORMANCE. Will their coder be able to provide proper documentation for increased performance? No….the coder is not in the room during the procedure to know of a performance increase. The physician and his/her staff MUST document well in order to warrant their pay-for-performance.

And physicians must have the TOOLS to document well… an 8½ x 11 “Remember to Document ‘X Y & Z’ Diagnoses on Your Patients!” stuck to the wall in the physician’s lounge is not a tool to help doctors document well. Give them an easy to use product (ComplyMD) that will enable them to capture appropriate data to document appropriate diagnostic and procedural data to warrant accurate reimbursement and rewards for performance.  

Another concern is, how much incentive pay is enough. There is no universal standard to determine which measures qualify for bonus pay — or how much — so some doctors end up filling out a lot of paperwork to comply with different insurance plans. The administrative costs often outweigh any financial benefit they see for pursuing improvements. “If health plans want physicians to participate, they’d be much better off collaborating beforehand to set norms,” says Hindy Shaman, director of health industries for the consulting firm PricewaterhouseCoopers. “Doctors won’t waste their time if they have to fill out 20 different forms.”

Ms. Shaman is correct – doctors do not want to be bothered with administrative duties, filling out forms, in order to get rewarded for their work. A simple solution would be a type of systematic reform that would set the norm beforehand….but we know that will many insurance companies and plans, this type of collaboration is a long way down the road, if even a possibility at all. Since there’s not a universal standard for measuring bonus pay, physicians should document as accurately and thoroughly as possible in order to warrant bonus pay from the insurance companies.

The jury is also still out on whether pay-for-performance plans ultimately benefit patients….. Neubauer worries that some patients could be denied necessary care under the new regime. “A doctor may just decide not to see a difficult patient who brings down his averages on certain measures,” Neubauer says.

That’s a fair concern. But on the flip side, many physicians (I hope) would not ethically deny necessary patient care. And even more than that, they would be measured across the board of other physicians as a better doctor who took better care of a sicker patient. But, the *key* in that is proper documentation of the patient’s diagnoses and the procedure(s) performed. We must make it easier for physicians to document these diagnoses because if you ask many physicians exactly what is wrong with their patient, many could not tell you in their procedural documentation all the diagnoses of their patient. This is where I believe physicians are not using their resources to collate the patient information found in the patient’s medical records chart, anesthesiologist’s reports, etc. The problem is that healthcare information has not found a systematic reform for data collation, but even more than that, physicians are not working smart to get paid for the work they’re doing.

There’s at least one undeniable benefit of pay-per-performance programs: they’re forcing doctors and hospitals to pay closer attention to quality controls. So while pay-for-performance may be an imperfect solution in an imperfect system, she adds, “At least it’s a step in the right direction.”

Great point. P4P initiatives are forcing physicians and hospitals to pay closer attention to quality controls. While some may frown upon P4P, the industry as a whole should embrace it, because like it or not, better data through better documentation is demanded. And even if it’s not enforced right now, it’s coming down the pike, so why not play the game now? Physicians who are better documenters will be rewarded not only financially, but across the board when measured against their peer physicians. Play the game. Physicians, become better documenters. Facilities, make it easy on your physicians by giving them the proper tools to capture accurate and thorough data – give them ComplyMD.