Do quality measures disillusion young doctors?
Recently at a full meeting of our seven-office, 25 physician practice, the topic of incentivizing doctors through quality medicine was discussed. The days of straight fee-for-service payments are gone. Many of us get separate bonus payments for quality medicine.
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Whether you participate in CPC+ (Comprehensive Primary Care Plus), MSSP (Medicare Shared Savings Program), or separate arrangements with private insurers, you are probably receiving a portion of your money as a bonus for quality. The quality payment is based on a score that can encompass how well you hit your quality metrics, proper coding (including Hierarchical Condition Categories-HCC codes), documentation and citizenship.
One of our newest doctors was questioning the value of paying doctors for quality. She expressed concerns that this was making it difficult for her to practice medicine without second guessing her motives. If patients are going to hurt the practice’s financial bottom line by causing adverse scores, are they patients we want to continue to serve?
As an example, say you have a new 55-year-old patient who comes in to the practice for a routine physical. As the interview goes forward, you appreciate what a nice man this is. You both have black labs and two sons. You are bonding well in the first few minutes. However, as you get into the nitty gritty of his health issues, he promptly refuses all screening tests and doesn’t want any more medications. The patient does not want a colonoscopy. Nor is he willing to treat his high cholesterol with an LDL of 211. And although he understands the importance of good control of his diabetes to avoid long term complications, he is adamant that his hemoglobin a1c of 9.1% is fine.
He will not agree to any more diabetes medicines, because he is sure they will cause him to gain weight. Our young colleague at this point is no longer appreciating this nice man. She is rolling her eyes on the inside and thinking, “Great, now I’m going to get dinged.” By this, of course, she means she will score poorly on her quality metrics and lose out on the shared bonus money. This has happened to all of us at one time or another. Patients we respect and care for causing us to lose money by not meeting the insurance company’s quality goals.