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Defamation
If a report questions the quality of care administered by a physician, would the
peer review privilege apply? Are the network decisions regarding credentialing
and termination protected from discovery? Are patient surveys subject to
discovery?
Malpractice
Do reported quality indicators make physicians more susceptible to malpractice
claims? Will quality rankings be admissible in a malpractice lawsuit?
Privacy
P4P arrangement may involve the sharing of patient information, which would
trigger applicable privacy laws. HIPPA concerns will need to be addressed or
provider confidence will be an issue.
Also, in the future, medical staff by laws, and rules and regulations need to be
reviewed and possibly revised. Medical staff policies need to be reviewed and
possibly revised to address a provider’s performance. Both the hospital and the
medical staff should consider establishing loss control/loss mitigation strategies
related to outcome data use.
Is P4P Here to stay?
As reported in Health Leaders News on August 1, 2006, “100 healthcare leaders
from hospital, physician, supply chain and policy sectors were asked to rank the
top 10 most important issues that are transforming US healthcare. Pay-forperformance
programs were ranked #1.”
Paul Danello, former counsel DHHS, OIG wrote recently, “This is the beginning
of the third wave of reimbursement, not some fad.”
Mark McClellan, 2005 in “Quality, Safety, and Transparency: A Rising Tide
Floats all Boats” wrote, “During the next 5 to 10 years, P4P could account for
20% to 30% of what federal government pays providers.” While Leslie Norwalk,
CMS wrote : “The Premier Hospital Demonstration is showing that even limited
additional payments, focused on supporting evidence-based quality measures,
can drive across-the-board: improvements in quality, fewer complications and
reduced costs.”
Another CMS leader was overheard comparing the CMS P4P pilot to the study
of a new drug. His analogy compared P4P to a new drug, and our current payment
mechanism to the placebo. His analogy was that P4P was curing patients while
the placebo group was remaining ill. He joked that possibly we should call off
the study, throw away the placebo, and “cure everyone” by implementing P4P!
Overall, it looks like Pay for Performance has the right idea to at least improving
the quality of care for patients. Although the providers find the program to be
costly and unfair, it would appear that at least the patients are reaping the
benefits of a better quality of care.
Dan Bonk is the Executive
Vice-President, Central Region of
Aurora Healthcare, a successful
senior healthcare leader for over
25 years. He is also an Advisory
Board Member of the Medical
Tourism Association.