Once again it seems that payers, led by Medicare, are on the verge of striking out in a new direction to compensate physicians and facilities for the services they provide through various pay-for-performance initiatives. What will P4P mean for the business of neurosurgery?
One can take either a pessimistic or optimistic approach in answering that question. The pessimists will claim that P4P is just the latest scheme payers have devised to increase their profits on the backs of providers. How will “quality” be determined? What appeal processes will be in place? How will fixed costs be covered under a quality pay system? These and a thousand other questions will haunt the pessimist’s mind. Gloom and doom will be the order of the day.
Is there a realistic, optimistic approach to P4P that is not simply Pollyannaish? There is, and neurosurgery is in the perfect position to embrace this latest shift and make it work to its advantage.
First, the technology that allows the capture of data needed to demonstrate and prove quality must be embraced. NERVES, the Neurosurgery Executives’ Resource, Value and Education Society, has begun that process by developing the exclusive Neurosurgery Practice Annual Survey, which was conducted last fall. While the neurosurgical community’s enthusiastic participation in the survey was encouraging, there is a long way to go before neurosurgery can effectively compete with the payer community on the amount and accuracy of the data available. As the move toward basing reimbursement on quality measures advances, all neurosurgeons and their practice administrators should be highly motivated to assure that their work is appropriately compensated. Participation in the survey process will no longer be an option; it will be an essential tool.
Second, serious efforts toward collaboration and cooperation in finding common approaches to patient care are necessary. Physicians are trained to be independent and decisive. That training can lead to an environment where posturing and position become more important than practical solutions. A genuine openness to alternative approaches will enable neurosurgeons to thrive under a P4P approach. Cooperation and collaboration will be required for physician interactions not only with one another but also with facilities. Physicians and hospitals will need to find new ways to align incentives. A genuine effort to develop systems and approaches to patient care that enhance quality and control cost will be essential. A recognition that sound business approaches will benefit all providers, physicians and facilities, will enable resources to be effectively and efficiently utilized.
Lastly, it is essential that the neurosurgical community is involved in learning about the P4P approach to reimbursement and in designing the matrixes that will be used to determine quality measures. To that end, NERVES is devoting its spring educational meeting to this topic. Alice Gosfield, an attorney and recognized expert in the area, is the keynote speaker at the April 15-16 NERVES meeting in New Orleans, immediately before the 2005 AANS Annual Meeting. In addition, the Council of State Neurosurgical Societies is preparing to focus on the topic during a fall educational meeting. All of organized neurosurgery will need to focus on providing every practicing neurosurgeon with the tools needed to win in the P4P world.
Every challenge provides opportunities. While the P4P initiatives could be viewed as yet another threat, neurosurgery alternatively can choose to accept the challenge and take advantage of the new opportunities it presents.
Mark Mason is president of NERVES, www.nervesadmin.com, and practice administrator at Neurological Surgeons PC in Nashville, Tenn.