Pay for performance: How fast is it spreading? - Fairly quickly, our survey shows, but it's still more common among primary care physicians. And HMOs are more likely to offer it than PPOs.

Pay for performance: How fast is it spreading? - Fairly quickly, our survey shows, but it's still more common among primary care physicians. And HMOs are more likely to offer it than PPOs. - Medical E

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Pay for performance: How fast is it spreading?

Fairly quickly, our survey shows, but it's still more common among primary care physicians. And HMOs are more likely to offer it than PPOs.

Nov 4, 2005
By: Ken Terry
Medical Economics

The pay-for-performance concept continues to work its way into medical practice. Health plans, employers, and government agencies were running more than 100 P4P programs in March of this year, and the number continues to grow as more sponsors come aboard. CMS could accelerate the process: It launched a P4P pilot project involving 10 large medical groups earlier this year, and it's expected to start another pilot for smaller practices in the near future.

Who has a P4P contract?

Congress is also getting into the act. Bills in both the House and Senate make provisions for rewarding physicians who meet quality goals and punishing those who don't.

Big-group doctors see more P4P

With all of this activity going on, Medical Economics decided it was time to find out just how much of an impact pay for performance is having on physicians' lives across the country. So, in March, as part of our Continuing Survey, we asked office-based MDs and DOs in 23 specialties about P4P. Their responses show that it's starting to have a significant influence—24 percent of all respondents and 30 percent of primary care doctors say that at least one health plan they contract with offers P4P.

Pay for performance varies by region

It's not surprising that these programs are still targeting primary care doctors more than specialists, since fewer measures have been developed in specialty areas. Also, primary care physicians provide more of the preventive and chronic-disease care that pay for performance is designed to improve. Nevertheless, specialists won't be off the hook for long: Med-Vantage, a consulting firm in San Francisco, reports an 11 percent growth in P4P programs for specialists in just one year.

P4P is usually paid as a bonus

Also not surprising is the fact that pay for performance is most prevalent in New England and the West Coast. (It's also big in Minnesota.) P4P programs generally start with HMOs, which have greater penetration in California and Massachusetts than in the South or the Midwest. While an increasing number of pay-for-performance programs now include PPOs, it's an administrative challenge. Given that PPO patients can self-refer to any network physician, pay-for-performance sponsors have difficulty determining which doctor or doctors should get credit for providing particular services to the patient.

But the percentage varies by region

Our survey shows that the degree of a doctor's HMO participation is directly related to the amount of P4P he's being offered. A physician's PPO participation bears no relation to his P4P options; but the more PPO business he has, the less likely he is to be involved in a P4P program.

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