Have you ever gone to Google and entered your name for a search? Or just entered Urologist and your city?
Chances are either way you approach a search, among the top returns are going to be physician quality rating sites. Congress, large corporations and patients are all looking for more for the their health care dollar. Insurance companies, Medicare, Medicaid and other programs are reacting to the demand.
The Physician’s Quality Reporting Initiative (PQRI) and Pay for Performance programs are getting more attention. We hear a number of physicians commenting that the programs are unfair, biased and have nothing to do with Evidence Based Medicine (EBM), the fact that physicians and even payers agree that the data for true EBM is sorely lacking is not stopping the market place reaction.
What can you do?
Of course you have options, here are few to start you thinking, followed by a few recommendations to help you start reacting or at least planning for the future.
1) DO NOTHING.
Most physicians are already too busy to worry about adding new processes and procedures to start collecting data related to quality. Further data analysis and packaging of quality data to prove that you are quality provider will take time away from your patients. Although we disagree with the bury your head in the sand and wait for something to effect your income approach, there is an argument for doing nothing. First, there are more patients that will need care in the next few years than providers. And of course time spent away from providing care costs you money right now.
However, if you wish to work less and make more in the future the best method is to change the way you market your services. Couple this with the shift to more first dollar out of pocket for patients and the fact that Insurers are going to develop and use quality measures that will effect patient flow you may have little choice. It is our strong belief that the quality argument is just beginning, doing nothing now will cost you later.
2) PARTICIPATE
Actively submitting codes to PQRI is a good start. The process to start at this point is relatively easy and although the program has seen its share of problems most are having little trouble getting codes submitted to Medicare. The payment from Medicare is small for participating but is not the primary reason for playing the game. Ultimately there are many who feel that lists being generated for those who play and those who don’t play for use in the future. However, a good reason to participate is that Medicare represents the best chance at influencing treatment guidelines at this time. Finally, if you do not participate Medicare has demonstrated it is not afraid to act without full data or physician support, like it or not quality based pay is coming. In other words lead, follow or get out of the way.
Of course participation is a pain and the pay is too low. Many are worried that the data is being developed to use against the physicians in the future. The argument against participation is that a lack of data makes it harder to enact protocols.
3) ANTICIPATE
Collecting data on your performance and comparing it to that our your Urology colleagues or even better contributing to a database that can be accessed by you without payer control can be done easily. Working in conjunction with other partners PRS has developed a tool box that will allow Urologists to add to a national Urology Dataset and access the data to compare yourself. The tool kit is easy works like a clearinghouse, a service you already use and is reasonably priced. Long term prospects for the database will provide protection and control for medical care by physicians and not payer organizations. Short term the tool helps provide much needed assistance with contracting and productivity analysis with benchmarking. The project as Urologists generate more data will be more accurate and useful than any payer developed data set. The process is secure and releases your data to no one that does not already have access to your data.
Of course the slight increase in cost may not pay off right away and you could wait until the data set is stronger to join. Additionally, the specialty society may come up with a free tool if the legal aspects can be ironed out. Or perhaps the government or a group of payers will provide you with access to your data and that of others without manipulating the information so that you can prove your quality to patients and payers.
