HMOs to pay for performance – Customer Satisfaction Counts – health maintenance organizations; performance standards and salary bonuses to ensure quality

HMOs to pay for performance – Customer Satisfaction Counts – health maintenance organizations; performance standards and salary bonuses to ensure quality – Brief Article

Todd Raphael

The managed-care industry, not one of the more popular sectors in American business, is trying to change. It’s hoping to improve the quality of health care by paying doctors more for doing a better job.

Aetna U.S. Healthcare, Blue Cross of California, Blue Shield of California, CIGNA, Health Net, and PacifiCare are going to agree on a set of standards for health care, and then may give bonuses next year to physician groups that meet them.

Some HMOs, such as U.S. Healthcare, have on their own tried similar pay-for-performance models to reward doctors. This is the first time that such a system has been planned on a large scale–throughout California, the nation’s most populous state.

The groups plan to develop a balanced scorecard–a table with certain measurements physician groups will need to meet–to see how well the doctors are protecting against and treating diseases. Points may be given, for example, for immunizing a certain percentage of children against chicken pox, polio, measles, and hepatitis B. Or, points may be given based on the percentage of a doctor’s diabetic patients whose blood-sugar levels are kept under control.

The scorecard will measure patient satisfaction, based on surveys given to a sample group. But most patients are unlikely to see immediate changes because of the proposal.

Peter Warren, spokesman for the 35,000-doctor California Medical Association, says members have many concerns about the idea.

Doctors could be penalized, for instance, because they’ve chosen to dedicate their practice to patient populations that are poorer, have less education, and have less time to attend to health needs. The scorecard could show that these patients didn’t get their immunizations on time. Doctors serving these patients would be punished, and the incentive for doctors to practice in less-affluent areas would diminish.

Warren says doctors are also concerned that money will be taken away from other health-care needs to pay for the bonuses.

COPYRIGHT 2002 ACC Communications Inc.

COPYRIGHT 2002 Gale Group