Oncologists may have an opportunity within a year to im-prove patient care while increasing their revenue through participation in pay-for-performance initiatives, according to a nation-wide survey of oncologists and California health plan officials.

California health plans have been offering pay-for-perfor-mance programs to primary care physicians for about five years — paying millions of dollars in bonuses to practices that have high scores on quality benchmarks. Starting next year, oncologists are expected to have an opportunity to participate in these bonuses programs.

The objective is to award physicians who follow patient care guidelines that have been established by a peer group. The American Association of Clini-cal Oncologists has a deadline of December 31 to complete the benchmarks that will be used by health plans for pay-for-perfor-mance initiatives.

Private health plans have been moving toward pay-for-perfor-mance programs for years, and Medicare is expected to follow soon. To that end, physicians need to be prepared to participate in the programs.

OTN Services, a practice management company in South San Francisco, commissioned a national survey of oncologists to gage their knowledge, interest and opinion of pay-for-performance programs. Supportive Oncology Services Inc. conducted the survey.

“We wanted to know how much oncologists know about pay-for-quality initiatives,” said John Amos, CEO of OTN Company, which owns Onmark Services. “Pay-for-performance is on everyone’s mind, but it re-ally hasn’t been defined yet. And these initiatives will be apart of every physician practice and fee schedule.”

And oncologists agree. Slightly more than 80 percent of oncolo-gists surveyed said they expect pay-for-performance programs to become a reality in oncology, and 80 percent also believe they will be involved in such programs within the next 12 months. Highlights from the survey include:

•85 percent of oncologists purport to understand the concept of pay-for-performance initiatives.
•60 percent believe the initiatives will improve the outcomes of cancer patients.
•65 percent say standardized performance measures, that can be quantified, are one of the better ways to provide quality care in oncology.
•75 percent are willing to work with managed-care to develop pay-for-performance initiatives.
•80 percent would adopt evidence-based standardized treatment guidelines.
•70 percent believe regimen standardiza-tion will help control costs, improve out-comes and increase practice efficiencies.

Technology will play an even greater role in the physician’s office when pay-for-performance initiatives are adoptedese programs will require excellent data man-agement to be sure the right information is collected to create a score on the physician. Unfortunately, at least 45 percent of oncolo-gists surveyed did not have electronic medi-cal records, a staple necessary to participate in pay-for-performance programs. But most oncologists plan to install such soware dur-ing the next year, according to the survey.

Health plans have mostly worked with medical groups and individual practice associations on pay-for-performance pro-grams, and these organizations already have sophisticated computer systems in place.

In California, health plans paid a total of $100 million in bonuses to primary care physicians last year, and Blue Cross of California alone paid $65 million, said Dr. Michael Belman, vice president and medical director of quality management for Blue Cross.

“The amount of money we have made available for the program has gotten the medical groups’ attention,” said Belman. Physician’s fee schedules have been changed or cut, leaving them with less money at year-end. Some physicians view the pay-for-performance programs as a way to earn back some of the money that has been cut out of their revenue.

“I received $1.3 million from the program last year,” said Dr. Ron Bangas-ser, family physician with Beaver Medical Group in Redlands and chair of the tech-nical advisory committee for the Inte-grated Healthcare Association, a nonprofit group of industry and medical leaders who work together to develop pay-for-perfor-mance programs.

This is likely the only way we are going to get more money, because we are not go-ing to get more money through contracts,” said Dr. Bangasser.

The next step is for the American Society of Clinical Oncologist to finish writing guidelines in December that health plans will use to grade oncologistsASCO will submit its guidelines to the American Medical Association, which is coordinating a variety of specialty organizations to write guidelinesguidelines will be tested next year to make sure they work. Once they are finalized, health plans can start us-ing them to implement the programs.

More than 65 percent of oncologists sur-veyed said the best way to implement pay-for-quality programs is to have uniform measures, but that might not happen. Dr. Belman, with Blue Cross, agrees that uni-form measures are ideal, but he said health plans would adapt the national standards to their own programs.

“Medicare is going to do this and they are the 900-pound gorilla, so we need to be ahead of the game before Medicare writes their own standards,” said Dr. Bangasser.

— By Troy May

Posted on November 13, 2006 09:51 PM