Pay for performance is well on its way

The move to pay for performance is an opportunity to rebuild medical care in the UnitedStates, according to Michelle Eads, MD, of Pinnacle Family Medicine near Colorado Springs, Colorado.However, many payers are paying for performance that may have little to do with patientoutcomes.

"Pay for performance is often driven by treatment guidelines," Dr Eads told attendees at theAmerican Academy of Family Physicians 2007 Scientific Assembly on Thursday. "Since we take care ofthe entire body, not just an organ system, we often see guidelines and performance targets that arein conflict. Pay for performance can encourage physicians to avoid clinically difficult patients andnoncompliant patients."

The solution, she said, is to adjust primary care practice to boost patient satisfaction withcare. A patient-centered practice can expect to produce better patient outcomes because moresatisfied patients also take a positive, proactive role in their care.

"You get really good outcomes when you involve patients in setting treatment goals andgetting them involved in meeting those goals," Dr Eads said.

In her practice, for example, 100% of hypertensive patients have met their blood pressuregoals, she reported. That compares with 15% of hypertensive patients meeting blood pressure goals ina recent survey of internists.

"You can get very good pay for performance when you help patients care for themselves," shesaid. "The key is getting patients involved and keeping them at the heart of their own care." Putting patients first takes a different practice model, Dr Eads added, called PatientCentered Collaborative Care (PCCC).

The single most important step in implementing PCCC is improving access. Many physicians have movedto an open access model that allows patients to get a same-day appointment.

But face-to-face office visits are just one type of encounter. She also uses onlineencounters, telephone calls, email, virtual visits, and group appointments.

"If all I have to do is a medication adjustment, why insist that a patient take a half-dayoff work to come see me? That's the kind of care than can be handled with a quick phone call. Itmakes the patient happier, it makes me happier, and it provides better care than a traditionalvisit."

Easier access includes the practice Web site, as well as providing online links to reliableinformation sources, such as WebMD and the Mayo Clinic.

In other cases, care does not have to be delivered by a physician. Telephone coaches are auseful adjunct for patients who have an established treatment plan but are having trouble meetinggoals.

"Telephone coaches are people trained in problem solving, not medicine," she explained. "Theywalk patients through their own action plan to make sure the plan gets translated into action.

Studies show that just three phone calls can alter patient behavior for at least 12 months.You get great outcomes and you get satisfied patients."

Multiple studies have shown a strong correlation between patient satisfaction and positiveclinical outcomes, she added. Studies also show strong correlations between patient and physiciansatisfaction in practice.

"It takes a very different mind set to focus on patient satisfaction," Dr Eads cautioned. "Weare used to being in the driver's seat with people adhering to what we say. Patient-centered careputs patients in the driver's seat."