Independence Blue Cross in Pennsylvania recently announced it would significantly boost its commitment to rewarding quality—not quantity—when it comes to reimbursing physicians. The plan is investing some $47 million in supplemental income to primary care physicians, with $33 million of that linked to pay-for-performance measures. In addition, the Blues Plan will offer additional financial incentives to primary care practices adopting the “patient-centered medical home” model of care delivery.

This type of reimbursement push can only continue to grow, as the industry seems to be waking up to the fact that it is much less expensive to prevent diseases than it is to treat them after the fact. And that is the very heart and soul of primary care medicine—preventive maintenance. And surely, with the looming shortages of family and primary care physicians, such economic boosts can only help to level the playing field. Physicians are discussing recently published surveys citing how the salaries of subspecialists are considerably higher than generally trained physicians. They note that among younger residents and medical students, many are eyeing lucrative careers in the sub-specialties, which are more highly compensated than family medicine or primary care. Can you blame them, given the huge debt load they will likely carry upon graduation?

The medical home model puts the primary care physician at the center of the patient life. And it depends on a robust IT infrastructure to support the effort—which requires communication and coordination among all caregivers, the bread and butter of an EHR.

A paper from the American College of Physicians spells it all out.

The backbone of the model, the ACP notes, is the “adoption and use of health information technology for quality improvement…and provision of enhanced communication access, such as secure e-mail.” That makes sense in context of managing patient outcomes. It’s unclear how a paper-based group practice could ever track, say, its diabetic patients. The short answer is, they can’t. You need a database and corresponding alert technology to keep tabs on who is due for what test when. 
This idea of rewarding quality may strike those outside the industry as a bit odd. Patients might think, “Gee, I thought they were doing that all along.” But the shadow of fee-for-service medicine is a long one, and for a variety of reasons, the fees for many subspecialty procedures greatly surpass those paid to the primary care physicians who are the first line of defense for most of us. Independence Blue Cross’ tacit endorsement of the EHR suggests some major changes on the economic horizon of medicine are forthcoming.


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