Government P4P Programs:

Pay for Performance - Is Medicare a Good

Candidate? Albert W. Morris, Jr., M.D. President

National Medical AssociationThe Second National Pay for Performance

Summit

Beverly Hilton Hotel, Beverly Hills, CA

February 15, 2007

Health Disparities Overview• Blacks lead the nation in 12 of the top

15 leading causes of death.

• Black infant mortality is 2.5 times higher than that of white babies.

• White men outlive black men by 7 years; and white women outlive black women by 5 years

• There are 85,000 to 130,000 “excess deaths” among blacks each year.

IOM, 2002

Unequal Treatment

Disparities in healthcare…

• Are “remarkably consistent” across 10-year corpus of literature

• Occur in every investigated disease area

• Persist even after accounting for insurance, severity of disease, and patient compliance

• Result in higher mortality for minority patients

AHRQ National Healthcare Disparities Report

2006

Racial disparities in healthcare quality exist…

• Across all key measurements of healthcare quality, including effectiveness, patient safety, timeliness, and patient centeredness

• Across all levels of care, including preventive care, acute care, and chronic disease management

• Across all healthcare settings, including primary and dental care, emergency departments, hospitals, & nursing homes

Utilization & Compliance

Minorities are more likely than whites to…

• Avoid care

• Delay seeking care

• Not comply with care

Physician Practice Patterns

• Minority doctors are more likely to serve minority populations.

• Patients tend to rate their physicians’ communication style higher in race-concordant relationships.

• Minority patients report higher levels of healthcare satisfaction when receiving care from minority physicians.

Key IOM Recommendations

DHHS should…

• Implement P4P in Medicare using a phased approach.

• Implement a monitoring and evaluation system.

• Assist providers with data collection and reporting.

NMA Task Force Recommendations (1 of

2)• Quality measures must be delineated from

cost containment measures.

• All measures must be culturally relevant and stratified to the patient population.

• Reimbursement formulas must be appropriate for the patient populations served.

• Capacity-building support must be provided to small and disadvantaged providers.

• Ensure ample input from a diverse array of physicians and patients.

NMA Task Force Recommendations (2 of 2)

• Provide physician and patient education.

• Evaluate impact on solo and small practices.

• Focus on clinical data over claims data.

• Repeal the Sustainable Growth Rate framework.

• Use a voluntary and phased approach in the early stages.

QUALITY

Doing the right thing regardless of who the

patient is…and regardless of who’s looking.