Globe: Partners docs rewarded for taking on new, complex patients

Liz Kolawczyk does a good job talking to a lot of docs for this story:

The Harvard-affiliated hospitals are tying about 10 percent of doctors’ salaries this year to the size of their practice and the complexity of their patients’ illnesses.That means the hospitals’ 360 employed primary-care physicians can increase their pay, now roughly $200,000 a year for those who work full time, if they see more patients than the average, or if they have many patients with multiple medical problems. Their pay can fall if they take care of fewer people.

The Partners rep argues that the hospitals have “a social obligation to provide access to care.’’  The story includes a  more believable explanation for the change: payers are moving toward global payments driven by volume and quality. Doctors will be rewarded for keeping patients healthy, rather than for performing a lot of procedures. The quality measures are supposed to keep the new approach from turning into a 1990s-style managed care system that encouraged less care, not better care.

But, the approach sounds a little too HMO-like for some folks.

David Cutler, a health care economics professor at Harvard University, believes the changes are good for patients, as long as the hospitals follow through on their promise to provide qualified nurses and assistants to help doctors and the doctors are willing to delegate work to them.

“What people are afraid of is a return to the managed-care era where the doctor has to see patients every seven minutes and gets frustrated,’’ he said.

So, how to get at quality? Two studies in Health Affairs suggest that the path to better care remains elusive.

One found  “Medicare’s seven-year public reporting initiative for hospitals, Hospital Compare, had no impact on reducing death rates for two key health conditions and just a modest effect on a third. That’s the conclusion of a just-released study that raises questions about the initiative’s ability to improve the quality of care provided by the nation’s hospitals”

Another, done at Harvard, found that docs using electronic health records actually ordered more tests, not fewer, than those using paper records. Kaiser Health Newsreports

Researchers found that office-based physicians were actually 40 to 70 percent more likely to order an imaging test if they had access to computerized imaging results. The study is based on data from the 2008 National Ambulatory Medical Care Survey of 28,741 patient visits to 1,187 physicians.

EHRs may be yet another example of a health care solution that looks great on paper, but “when you actually try to implement it in real world settings with real patients” it may have some “unintended consequences,” says lead author Danny McCormick, a primary care physician and assistant professor of medicine at Harvard Medical School.



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