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Why are P4P and quality important areas of focus for the Society?
- Pay for performance has the potential to improve care for older adults.
- Current payment systems do not consider quality in determining reimbursement.
- The incentives the current reimbursement systems provide sometimes promote poor quality care.
- The present fee-for-service payment systems pay providers based on the number and complexity of services provided to patients without regard to quality, efficiency, or impact on health outcomes. Pay for performance has been proposed as one strategy for correcting this deficiency.
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Are there any programs in place to test potential P4P models?
Launched July 1, 2007, Medicare's Physician Quality Reporting Initiative (PQRI) provides a financial incentive for providers to participate in voluntary quality reporting. Eligible providers who successfully report self-selected quality measures chosen from the PQRI's designated set of measures on claims for services provided between January 1 and December 31, 2008 may earn a bonus payment. This payment, subject to a cap, may equal as much as 1.5% of total allowed charges for services covered by the Medicare physician fee schedule. (Payments for lab tests and drugs are not included).
The PQRI's 119 evidence-and consensus-based measures relate to important aspects of care that have been linked to improved outcomes. There are seven geriatrics measures. These concern: screening for future falls risk; medication reconciliation; advance care plans; assessment of presence or absence of urinary incontinence in women 65 and older; plans of care for urinary incontinence in women 65 and older, and pneumonia vaccinations for patients 65 years and older. All physicians must report a minimum of three quality measures and the Centers for Medicare and Medicaid Services (CMS) expects geriatricians to report at least three of the geriatrics measures. In addition, geriatricians can choose measures other than the six listed above, if these measures are applicable to their practices.
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What is the Society's position on Quality and P4P?
The American Geriatrics Society (AGS) strongly endorses efforts to ensure that every older person receives high quality, patient-centered health care. However, AGS also recognizes that if the unique needs of this population are not appropriately taken into account, pay for performance could actually result in a reduction in quality, particularly to the most vulnerable and frail older adults. AGS' P4P Proposal and Position Statement on P4P was developed to provide policymakers and health plan administrators assistance in moving payment toward a value-based purchasing system in order to achieve greater quality in health care outcomes for all older adult patients, including the frail elderly.
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