July 29th, 2009

Reports the Central Penn Business Journal:

Two years ago, nearly one out of every 10 patients at Eden Park Pediatric Associates was overweight. About 1 percent of patients at the Lancaster County practice had hypertension and 28 percent had high cholesterol.

Those are alarming numbers, especially in light of what they could lead to in 30 or 40 years. So Eden Park decided to do something about it.

The practice used Pittsburgh-based insurer Highmark Inc.’s pay-for-performance program, called QualityBlue, as a springboard to improve care.

“The physicians are amazed,” said Lynn Cramer, the practice administrator and a board-certified pediatric nurse. “They never thought we would be able to impact (patients) positively to the degree that the program has allowed us to.”

Pay-for-performance programs, in which providers’ reimbursement is tied to patient care, have grown nationwide over the past decade and have been proposed as part of federal health care reforms.

…

The term “pay for performance” encompasses several types of initiatives, said Lynn Leighton, vice president of health services for the Hospital & Healthcare Association of Pennsylvania (HAP).

For the past five years, Medicare has paid hospitals for reporting certain quality measures, she said. A few years after that, Medicare added a second piece to its pay-for-performance program by imposing reimbursement penalties for certain undesirable outcomes, such as high rates of hospital-acquired infections.

A third piece of the pay-for-performance puzzle, which has been proposed for Medicare but hasn’t been passed, is using increased reimbursements as incentives for achieving certain measures or for showing improvement.

Commercial insurers have taken similar approaches to pay for performance. Some pay — and penalize — based on performance, others provide additional payment for improvements, and a third group mixes the two, Leighton said.

Find out more at the CPBJ.