Pay-for-performance

We Are All Accomplices In The Great American Coding Swindle

"Membership in the American Academy of Professional Coders has risen to more than 170,000 today from roughly 70,000 in 2008." "The AMA owns the copyright to CPT, the code used by doctors. It publishes coding books and dictionaries. It also creates new codes when doctors want to charge for a new procedure. It levies a licensing fee on billing companies for using CPT codes on bills. Royalties for CPT codes, along with revenues from other products, are the association’s biggest single source of income" Aint that something? Okay, I would rank Elizabeth Rosenthal up there with Atul Gawande and Lisa Rosenbaum in the pantheon of standout healthcare writers active today.  They are all docs and have more skill in their writing pinky than I have in my entire body. They have a unique talent in stitching together narratives that speak to both docs and patients in their language--and do it within…

Dont Compare HM Group Part B Costs Hospital to Hospital. It’s About the Variation Between Individuals.

I have been and will be light on the blogging these days.  However, a new JAMA online first study out looking at hospitalist Part B cost variation deserves some attention.  Bestill my heart.  It's not about groups.  It's about individual physicians.  The gap between high- and low-spending doctors in the same hospital was larger than the gap in spending between hospitals. From the editorial: In this issue, Tsugawa et al3 analyze spending by individual physicians in relation to patient outcomes. The research team compared Medicare Part B spending per hospitalization by hospitalists practicing within the same hospital. To profile each physician’s level of spending, average Part B spending per hospitalization for 2011 and 2012 was used, then applied to clinical outcomes (30-day readmission and 30-day mortality rates) for 2013 and 2014. The split-sample approach mitigates bias if a physician treats a complex set of patients in one year and therefore has…

Online Ratings For Hospital CEO, CFO’s, etc.

This week's NEJM features an article on hospital-sponsored online rating sites for docs.  The author, Vivian S. Lee, M.D., Ph.D., MBA, a prominent health services researcher discusses the adoption and success of her program at the University of Utah and how the system uses a portal open to patients to evaluate staff. In the piece, she covers familiar ground. Early renunciation and eventual acceptance by faculty in a manner you can predict: initial fears of reputation and prestige loss give way to a stable system allowing docs to obtain feedback in real time to improve their game.  It is not all wine and roses in her telling, but like all things, the apocalypse never materializes, and the once unthinkable becomes business as usual. Docs adjust.  Life moves on. Also in her viewpoint, she cites a recent study of interest that continues to get a lot of attention whenever inquiring minds consider provider ratings.…