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In a dramatic change from the traditional managed care cost-cutting mindset, Blue Cross of California has announced it will begin using patient satisfaction measures instead of cost controls to calculate physician bonuses. Under the Blue Cross plan, doctors who score well on patient satisfaction and preventive care surveys can receive up to a 10% bonus on top of their regular quarterly managed care payment, starting in 2003. Before, such bonuses were determined solely by how well physician groups controlled costs.
More HMOs are expected to follow this move as a way to quell employer complaints about recent hikes in insurance premiums of 10% to 20%, by improving outcomes. Other experts also see it as a response by the managed care industry to the patient rights legislation that has been moving through Congress and state legislatures.
While Capitol Hill debates a national patient rights bill, eight states have already passed new laws allowing patients to sue their HMOs for denying what they felt was necessary medical care. "The decision to make this change was market-driven," says Michael Belman, MD, spokesman for Thousand Oaks, CA-based Blue Cross of California in "Employers want more value for their premium. From the provider side, we feel physicians who receive financial incentives to give quality care will be more satisfied."
San Francisco-based Blue Shield of California actually began its quality initiatives in January when it launched a separate quality incentive program. Under this plan, medical groups that meet established quality measures can increase their managed care payments by as much as 5%. Other organizations affiliated with Blue Cross of California, such as Blue Cross Blue Shield of Georgia in Atlanta and UniCare Health and Life Insurance Company of Thousand Oaks, CA, are also considering paying their doctors based on patient surveys.
PacifiCare Health Systems of Santa Ana, CA, has operated a quality reward system since 1998, based on about three dozen clinical measures. Under it, high-scoring groups are assigned more members, potentially resulting in higher revenues.
The first reaction from employers was a hearty thumbs up. "With the significant increase in health care costs, purchasers are increasingly turning their attention to the quality of care being provided because they question the increased payments they’re making," says Peter Lee, president of the San Francisco-based Pacific Business Group on Health. "There’s been more demand to improve health care quality as premiums have risen sharply in the past several years," he adds.
Despite the surface appeal of being paid when they keep patients healthier, some doctors are more weary of the messenger than the idea. "You just cannot trust health plans to come up with an answer that’s good for both patients and doctors. We’re simply suspicious that this is more of a public relations ploy than real change," notes Peter Warren of the California Medical Association in San Francisco.
The idea of patient satisfaction-based pay schedules also has its skeptics in the HMO industry. "Just because patients say they are happier because their access to a doctor has improved does not mean the technical quality of their health care has improved," says Robert J. Forster, MD, vice president of care for Florida Blue Cross and Blue Shield in Jacksonville. "Anyone who says different is just playing with smoke and mirrors."