In a move that could end up serving as a model for both private and public health care systems across the country, New York City’s public hospitals are poised to begin linking doctors’ paychecks to the quality of the care they provide patients, the New York Times reports.
Obamacare already attempts to shift the nation’s health care model towards one that rewards better care quality — rather than the volume of services provided — by tying safety net hospitals’ reimbursement rates to procedural benchmarks and patient satisfaction questionnaires. But elements of the yet-to-be-finalized NYC proposal would go even further than that, potentially tying physician groups’ salaries and bonuses to a variety of performance indicators in an effort to improve care quality and lower health care costs:
“I would expect that we’re going to see this become more and more prevalent in compensation arrangements,” said Alan Aviles, president of the city’s Health and Hospitals Corporation, which runs the city’s 11 public hospitals and is the country’s largest public health system, handling more than 1 million emergency room visits a year.
The corporation’s plan would make doctors’ raises dependent on their performance on quality measures. The details are being negotiated with the doctors’ union, but both sides expect to reach an agreement that incorporates the idea. [...]
The public hospital system has come up with 13 performance indicators. Among them are how well patients say their doctors communicate with them, how many patients with heart failure and pneumonia are readmitted within 30 days, how quickly emergency room patients go from triage to beds, whether doctors get to the operating room on time and how quickly patients are discharged.
Union officials said they were still fighting for wage increases, in addition to performance bonuses. The union has also proposed expanding the indicators to 20, including measures that would give doctors bonuses for going to community meetings, giving lectures, getting training during work hours, screening patients for obesity and counseling them to stop smoking. It has also proposed excluding some patients — like developmentally disabled patients, homeless people and those who have no place to go — from incentives aimed at reducing the time patients spend in the hospital.
The strategy is not without risks. Just as doctors take advantage of the current scheme — in which a caretaker is reimbursed by public insurance programs for the bulk and length of the services provided — through shoddy practices such as “self-referring” and “upcoding” their safety net patients, they might also learn how to game this new system. Other countries with pay-for-performance models have had mixed results as to the efficacy of such programs.
But with quality indicators that are structured soundly and an effective oversight and enforcement mechanism, the pay-for-performance plan presents the opportunity to improve care while curbing costs. Most importantly, it encourages a proactive health care system that is actually centered on Americans’ general well-being, rather than the reactionary “sick care” paradigm that currently dominates the American medical landscape.