NCQA To Announce Model To Identify Highest-Quality Primary Care Physicians, Establish Pay-for-Performance System

Main Category: Primary Care / General Practice
Also Included In: Health Insurance / Medical Insurance;  Public Health
Article Date: 08 Nov 2007 - 8:00 PDT

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The National Committee for Quality Assurance on Wednesday at a meeting of physicians, health insurers and employers in Washington, D.C., plans to announce a proposal that would revise reimbursements to physicians to help improve quality of care, the New York Times reports. The proposal would help health insurers and employers identify the physicians that provide the highest quality of care and encourage patients to visit those physicians.

In addition, physicians would receive reimbursements for services currently not covered under most health plans. The proposal, which seeks to encourage increased interaction between physicians and patients, would reimburse physicians, or nurse coordinators, for telephone or e-mail communications with patients after office hours. The proposal also would reimburse physicians for management of chronic conditions and would encourage them to transmit prescriptions electronically.

The American Academy of Family Physicians, the American College of Physicians -- Internal Medicine, the American Academy of Pediatrics and the American Osteopathic Association have endorsed some parts of the proposal. The physician groups have coordinated their efforts with several large health insurers -- such as Aetna, the Blue Cross and Blue Shield Association, Cigna, Humana, UnitedHealth Group and WellPoint -- as well as CVS Caremark, the Erisa Industry Committee, IBM, Medco Health Solutions and Walgreen.

Paul Grundy, director of Health Care Technology and Strategic Initiatives at IBM, said, "We are empowering doctors to once again have a doctor-patient relationship," adding, "We don't want to buy the kind of care we're getting any more. We have turned doctors into little chipmunks on a wheel, pumping out patients every five minutes" (Freudenheim, New York Times, 11/7).

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