Law includes incentives for MDs

LITTLE ROCK, Ark. -- Some doctors will be able to collect bonuses for meeting performance standards under the new Medicare law, and hospitals can earn higher payments by tracking how quickly and how well they treat patients.

Included in the 681-page measure that President Bush signed this week are financial incentives aimed at measuring and improving health care.

Too few health care organizations now allow themselves to be monitored, according to the nonprofit National Committee for Quality Assurance. In its annual report, the group blamed 57,000 avoidable deaths and 41 million sick days a year on a failure to follow best practices.

"As Medicare beneficiaries receive more choices, the quality reporting provisions in the bill serve two purposes," said Richard Sorian, the committee's vice president. They give information to help people pick their medical coverage and they make it possible to assess how well Medicare is providing care to older Americans, he said.

The law enlists the National Academy of Sciences' Institute of Medicine to develop uniform quality standards and a plan for paying providers for good performance. In trial programs, participating doctors will receive additional Medicare payments for meeting or exceeding performance standards.

Hospitals that voluntarily provide quality data to the Centers for Medicare and Medicaid Services, which runs the Medicare program, will receive 0.4 percent higher reimbursements for every Medicare beneficiary they treat.

The program already collects and distributes such data on nursing homes. Examples of the information being sought from hospitals include whether heart attack victims were given aspirin upon arrival and when patients with pneumonia first got an antibiotic.

The law calls on the new Medicare regional preferred-provider organizations that will come into existence in 2006 to measure how well they provide care and to report their data in order to continue participating in Medicare. Such organizations allow subscribers to visit doctors outside a network of physicians, but they have to pay extra.

Groups that have worked for years to monitor private doctors, hospitals and managed-care companies say all consumers will benefit if Medicare, the nation's largest purchaser of health care, has the power to track quality.

"Requiring more information for Medicare underscores the importance of public accountability and paves the way for those in the private sector to do the same," said Suzanne Delbanco, executive director of the Leapfrog Group, a Virginia-based nonprofit organization.

She said hospitals gradually are accepting more quality-control measures, but Leapfrog could only get 57 percent of hospitals to participate in its recent national survey.

Until now, only managed-care health maintenance organizations (HMOs) and local PPOs offering Medicare products had to make quality data available to the public. With those requirements in place, about 70 percent of all HMOs also reported the performance of their private plans voluntarily, figuring the measurement systems were already in place and the data could help them become more efficient.

But PPOs -- which serve about 120 million customers compared to 80 million with other managed-care plans -- have shied away from disclosing their quality scores, saying their looser structure made it harder for them to control such things.

Karen Greenrose, president of the American Association of PPOs, welcomed the new initiative but said existing reporting methods are not appropriate for measuring widely varying benefits and programs offered by individual PPOs.

"We have to make sure we aren't measured under the same umbrella as other managed care," she said.

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