A couple of years ago I wrote about this dude from CareFirst BlueCross BlueShield (can their name getting any longer?). At that time they wanted to give discounts to their customers who choose efficient doctors. Using data collected as part of its “successful” Patient-Centered Medical Home program, they were going to slow the rising health care costs by forcing their customers to these self-defined efficient doctors. In other words, it co-opted the PCMH machine and used it as a trojan horse to pick the doctors they wanted. Of course, the AAFP was no where to be found on this and never fought back. Flash forward and we have this same dude back in action. Chet Burrell, president and CEO of BlueCross Blue Shield, told the AAFP Board of Directors that they are now offering a plan that includes financial incentives to primary care physicians, but does not include penalties. Really? Smell’s fishy. What’s the catch? Well, here is what he wants:
- CareFirst asks primary care physicians in the program to form into groups of five to 15 physicians called “panels.” Smaller groups do not produce enough data and larger ones make collaboration too difficult, Burrell said. Most panels have about nine physicians. Panels are graded using a combination of engagement, patient access and appropriate use of services. The engagement score, which carries the most weight, includes patient satisfaction and working within the medical home model.
- Physicians in each panel hold monthly meetings to discuss the group’s performance and compare notes. CareFirst will not drop a physician from a panel for low performance — only in extreme cases where they refuse to cooperate with the plan — but it will allow the panel members to address struggling practices. Given the competitive nature of physicians, Burrell said, panels motivate each practice to maintain high standards and correct any substandard performance.
- CareFirst created a “patient care account” that acts as a scorecard for each patient’s activity and related costs, but it is not a substitute for an electronic health record system. To help physicians with referrals, hospitals and area specialists are assigned a grade based on their cost.
Sounds awesome, right? Burrell told the group that the average practice in the program received an additional $41,000 in revenue in addition to the participation fee. So, for all that work each doctor gets what? The practice got $41K but that doesn’t mean the doctor gets anything. If you are employed by a hospital they will steal that check. I know because I have seen of my prior hospital employers do to it to our practice. Even if the doctors got the check, that is $41k divided by nine with is about $4500 per doc. Does this really sound worth it? Sounds to me that the penalty is that they would stealing hours from my life to do worthless crap. No response in the article about how the AAFP board responded but dollars to donuts they lapped it up. A victory for PCMH once again!!Tweet