Bonus payments from insurers?

According to Crain’s Detroit Business, Blue Cross Blue Shield of Michigan has decided to financially reward another 3,000 more specialty physicians for making quality improvements and lowering patient care costs.

Under Blue Cross’ six-year-old physician group incentive program, participating physicians – 5,750 primary care physicians and 5,524 specialists as of July 1 – have received more than $75 million in bonus payments.

By adding more specialists, including podiatrists and chiropractors, Blue Cross intends to encourage all physicians work closer together to improve health outcomes for groups of patients.

“This is a logical extension of the patient-centered medical home model, which focuses on improving patients’ health through improved care processes and more coordinated relationships between patient and primary care physician,” said David Share, M.D., the Blues’ vice president of value partnerships.

“The natural extension is for these (medical home) practices to integrate patient care with specialists, using shared systems and processes so that patients’ health is managed across all stages,” Share said.

Physician evaluation

The medical establishment is calling for some significant changes to the way that Medicare data will be released and used to evaluate physician performance, according to FierceHealthIT.

In a letter to the Centers for Medicare and Medicaid Services (CMS), the American Medical Association and 81 specialty societies commented on a proposed rule that CMS published June 8. This rule addresses the release of Medicare Part A, B and D claims data for use in public physician quality reports. The Patient Protection and Affordable Care Act requires CMS to issue this data to qualified entities on the condition they combine it with private insurance information.

The AMA and its sister societies ask CMS to ensure that the data released is accurate and in a standardized format that can be compared with private insurance data. These standards should be applied specifically to risk adjustment and to attribution of data to the correct physicians, the societies say.

In addition, the societies note, physicians should have an opportunity to review the data on themselves before it is released. And they request that CMS ensure a “stringent overview of the review, appeals, and error correction process.”

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