By Tim Bonfield
Enquirer staff writer
Several big employers in Cincinnati and Louisville say they might have found a novel way to control the ever-rising costs of health care: paying doctors a bonus for providing high-quality care.
After completing the first year of a three-year pilot program that rewards doctors for meeting national standards in diabetes care, sponsors report the program has shown some success. The program, called "Bridges to Excellence," has been expanded to Boston and upstate New York, and has begun to attract national attention within the health care industry.
The program pays doctors who qualify an extra $100 a month for each of their diabetic patients. So a doctor in the program with 15 diabetic patients stands to collect an extra $18,000 a year in addition to normal fees for service.
So far, 55 doctors who specialize in treating diabetes, including eight individual doctors and three doctor groups in Greater Cincinnati, have signed up.
More than 7,000 diabetics are treated by these doctors. So far, the doctors have shared more than $127,000 in bonuses and they stand to collect much more. Other pilot programs in Massachusetts and New York - with varying bonus payments - focus on cardiac care and physician office practices.
Focusing on the quality of care - by reducing medical errors and by following standards of care based on the latest research - has become an increasing issue for health system reformers.
The bonuses are important because the current reimbursement system offers little incentive to provide quality care in many chronic disease situations. Instead, some doctors and hospitals can actually gain financially when complications from poorly controlled chronic conditions lead to more treatments.
Earlier this week, the National Committee for Quality Assurance reported that quality of care is improving in several areas, but wide variations in care that still exist led to an estimated 42,000 to 79,000 avoidable deaths and about $1.8 billion in unnecessary medical costs. The report looked at information from 563 health plans nationwide.
For example, more than 14,000 heart attacks and strokes nationwide could be avoided each year just through better diabetes care, the report states.
Enter the Bridges to Excellence program.
The program is co-sponsored by several large employers, including General Electric Co., Ford Motor Co., Procter & Gamble, the city of Cincinnati, and Cincinnati Children's Hospital Medical Center; UPS and Humana Inc. in Louisville; Verizon Communications and Raytheon Co. in Boston; and Hannaford Bros. Co. and Price Chopper in the Albany area.
Already, the diabetes program has shown that self-insured employers can save money while diabetic employees get better overall treatment, said Beth Hallgren, health care manager for GE.
While the program costs employers about $175 per patient per month, counting bonuses and administrative costs, the companies estimate they save $350 per member per month through reduced hospital visits, shorter hospital stays, less unnecessary testing and other factors.
The program asks doctors to meet standards set by the National Committee for Quality Assurance and the American Diabetes Association. For example, doctors must show that they regularly track blood sugar, cholesterol and kidney function tests for their diabetic patients. The test results also must show a high and growing percentage of patients whose diabetes symptoms are well-controlled.
In general, doctors who meet such standards do not have the lowest costs, but they also rarely have the highest costs when compared to other doctors, Hallgren said. Instead, the doctors' costs are more closely grouped in the middle and tend to remain stable and predictable - all positive factors to employers trying to plan their health benefits budgets.
In manufacturing, measuring quality improvement has become an established science, Hallgren said. But the concept has spread much more slowly in the health care arena - in part because quality has been harder to define and in part because most doctors do not work for large organizations that can push for standardization.
So instead of attempting to measure all sorts of physician specialties at once, the Bridges program is starting with fields where quality indicators have been well-established, Hallgren said. In years to come, the program is likely to expand to other fields.
Given the clout of the big corporate sponsors, the relatively small Bridges to Excellence program is being taken seriously by health insurers and by the government.
In May, UnitedHealth Group, one of the nation's largest health insurers, joined the program and announced that it will encourage physicians to participate.
"Good physicians deserve to be recognized for their efforts and patients deserve to know the physicians who are providing care consistent with the best scientific evidence," said Dr. Vince Kerr, president of Care Solutions at UnitedHealth Group.
Meanwhile, the Medicare system, Aetna, Tufts Health Plan in Massachusetts and other organizations are considering the Bridges program as they work on their own methods to promote quality care, Hallgren said.
Diabetes leaders
The local doctors and doctor groups included in the Bridges to Excellence program are: Robert Cohen, Don Fixler, Ronald Hsieh, Kenneth Kreines, Christopher Meier, Vidya Sundaram, Timothy Williams, David Wilson, Group Health Associates, Queen City Physicians and Springdale Family Medicine.
