On the (far) horizon: Pay for performance at a glance

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CHICAGO—Kimberly Applegate, MD, associate professor of radiology at Indiana University Riley Hospital for Children in Indianapolis, Ind., erased any lingering doubts about pay for performance (P4P) among attendees during a focus session held late Monday afternoon at the 94th annual meeting of the Radiological Society of North America (RSNA).  “P4P is here for the long haul,” Applegate said.
The good news for radiologists is that the specialty is not yet in the crosshairs, which gives the profession time to prepare. Applegate launched the session with a brief overview of pay for performance and quality, defining quality as patient-centered, timely, efficient, safe and equitable care. The goal of P4P is simple; the government aims to create incentives to deliver improved clinical quality and patient experiences using quality metrics.
A consortium led by the American Medical Association started developing performance measures in 2006, and to date, the feds have approved approximately 260 quality metrics. The initial incentive is a 1.5 percent bonus on Medicare procedures.
Only a handful of the approved metrics measures apply to radiology. Consequently, the radiologists face a slightly different mandate than their clinical colleagues. Pay for performance will drive better integration with clinical colleagues, Applegate said. “It will result in IT infrastructure for better reporting,” predicted Applegate.
The current placement of radiology on the back P4P burner will change given the exponential increase in amount of imaging in the United States. The Journal of American College of Radiology recently reported the U.S. spends nearly $16 billion per year on unnecessary medical imaging. In addition, 30 to 40 percent of imaging fails to provide information needed.
Applegate closed the session by highlighting upcoming priorities on the P4P agenda. These include coordination of care, transition, communication and planning.  How can savvy radiology groups prepare for the P4P future? Smart groups will invest in systems and processes that tackle target metrics and related objectives like communication and clinical coordination.