Should Doctors Be Penalized for Patient Outcomes?

Leigh Page


November 03, 2016

In This Article

Aiming for Better Outcomes in Diabetes and Oncology

Focusing on improved outcomes entails different work for different groups of patients. For diabetes, a chronic condition, a patient's motivation may ebb and flow over time.

The chronic care model, which is often used for diabetes patients, is meant to improve patient adherence, according to Kevin M. Pantalone, DO, an endocrinologist at the Cleveland Clinic.

"If the patient gets a headache a few days after starting a new medication, he or she may stop taking the drug and not let the doctor know," he says. "Under the chronic care model, nurse coordinators contact patients after the visit to make sure they're starting the med and that it's working well." This team care approach enables a physician to stay on top of the patient's adherence and lets the physician recommend a different treatment, or work with the patient to encourage them to be active in their own treatment.

Dr Pantalone doesn't think that meeting the single outcome measure for diabetes care under MIPS QP and other Medicare quality programs would be highly difficult. The measure requires physicians to report the percentage of their patients who have an A1c value of less than 9%, but he says the goal for individual patients with diabetes is set much lower, at less than 7%. That allows doctors "some wiggle room" in meeting MIPS standards, Dr Pantalone says.

Oncology Also Moves Toward Measuring Outcomes

Cancer care and payment, as with many other specialties, is moving toward measuring outcomes. In July, 195 practices joined the Oncology Care Model, a 5-year demonstration program that makes oncologists responsible for the effectiveness and efficiency of oncology care. Physician practices are engaged in payment models that include financial and performance responsibility for episodes of care involving chemotherapy administration to patients with cancer. The Centers for Medicare & Medicaid Services provides a $160 monthly management fee for each patient, which can be used to pay nurse coordinators to improve adherence. Like the ACO program, participating doctors with high quality scores who save money during a 6-month episode of care can also get extra payments.

Oncologists are beginning to embrace this payment concept, says Stephen Grubbs, MD, vice president of clinical affairs at the American Society of Clinical Oncology. "Initially there was some resistance among members, but I think they have come to understand that change is coming," he says.

Dr Grubbs counsels that when outcomes are measured, providing accurate coding using the International Classification of Diseases, 10th edition, becomes crucial. "To establish your risk and to be graded at the correct level of severity, you need to be putting in the right comorbidity codes," he says.


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