"Pay for Performance" in Pathology – Does It Perform?
A Vora, B Feltmann, J Pfeifer. Washington University, St. Louis, MO
Background: Pay for Performance (P4P) is a new measure instituted by the Centers for Medicaid and Medicare (CMS) in response to patient quality issues identified by the Institute of Medicine (IOM). The P4P system links compensation by CMS to measures of work quality, including improvements in patient care and pathology reporting. Per CMS, a financial incentive awarded to providers for the P4P program will result in improved patient care. However, no long-term studies have been performed in pathology to see if P4P benefits patients or their health care institutions. To address these issues, a retrospective audit was performed to determine the impact of P4P measures on patient care and financial reimbursement at our institution.
Design: A retrospective review of all breast carcinoma resections diagnosed by an academic pathology department at a tertiary care hospital was performed for fiscal year (FY) 2008 (June 2007-July 2008). Based on the pathology reports, resections were stratified to see if they met or exceeded defined P4P criteria, and the resulting professional and administrative costs of implementing the P4P algorithm were calculated.
Results: Of the breast carcinoma resections in FY 2008 (n=1,252), only 25% (n=319) were patients covered by the Medicare program; 100% of these cases met the inclusion criteria for P4P best medical practice and the performing pathologist's total Medicare allowable charge base was $290,239. The calculated P4P bonus on these charges was $4,354 (1.5% of the allowable charges). However, the retrospective analysis demonstrated that it had cost $5,870 to implement the changes in specimen processing and reporting to meet P4P criteria, and that there was a $330 administrative cost involved in submission of P4P claims. A similar analysis of colon adenocarcinoma resections showed that 100% of cases met inclusion criteria for P4P best medical practice, but that the costs of participation in the P4P program exceeded the reimbursement received (data not shown).
Conclusions: In a tertiary care academic pathology department, participation in the P4P program did not improve patient care (standard of care reporting criteria in the department met or exceeded P4P criteria in 100% of breast and colon resections prior to participating in the P4P program). Furthermore, the P4P algorithm did not provide a clear financial incentive (participation in the P4P program was associated with a net cost). We conclude that, in the setting of a tertiary care academic pathology department, patient care needs dictate reporting standards, not P4P initiatives.
Category: Quality Assurance
Monday, March 22, 2010 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 250, Monday Morning