“It’s not ridiculous money, but they’re paying you for work you’re already doing or should be doing in terms of good quality care.”
T
he BCBSTX Bridges to Excellence recognition pro- grams in diabetes and cardiac care pay qualifying physicians $100 per patient per year for giving their patients high-quality care. Some physicians in the program say they earned the bonuses simply by documenting the care they were already providing. Eduardo Sanchez, MD, vice president and chief
medical officer for BCBSTX, says the program allows the carri- er to reward good physicians, improve the care its beneficiaries receive, and lower costs for the company and for employers who pay for coverage.
He says it also helps physicians deal with a health care de-
livery system that is evolving from fee-for-service to fee-for- value payments. “We feel that on a noble front this is offering doctors op- portunities to be recognized for doing good work; two, to be rewarded for doing that good work; and, three, to begin orga- nizing themselves in a way that will make them viable practi- tioners in this evolved medical care delivery system that we’re moving into.” Texas Medical Association officials see tremendous opportu- nities in the increased revenue and improved quality that the BCBSTX Bridges to Excellence programs present. Plano family physician Christopher Crow, MD, chair of
TMA’s Council on Socioeconomics, participates in the diabetes program. He sees no downside to participation, other than the staff time it takes to pull the data. “It’s not ridiculous money, but they’re paying you for work
you’re already doing or should be doing in terms of good qual- ity care,” Dr. Crow said. “And the data they’re collecting is on things that you should be doing every time you see that patient.” Dr. Crow says his practice looked at clinical quality for years through their electronic medical record (EMR) sys- tem before signing up for Bridges to Excellence. Partici- pation in Bridges to Excellence didn’t re-
Eduardo Sanchez, MD
Christopher Crow, MD
18 TEXAS MEDICINE October 2011
ally improve their care because they had already made changes to ensure they were meeting nationally recognized standards. “If that had been the first time we looked at it, then most definitely it would have helped.”
Houston internist Lisa Ehrlich, MD, and her three partners completed the Bridges to Excellence recognition programs for both diabetes and cardiac care this spring and says the process was fairly easy. She had her billing staff pull the necessary data from their EMR system and upload it through the IPRO portal. (See “Taking the Right Path,” opposite page.) Dr. Ehrlich says it took her staff 12 to 16 hours to gather the data necessary to gain recognition and get approval for the incentive payments under the cardiac program, a little longer for the diabetes programs because more data were requested. They have already received payment for the cardiac patients but were still awaiting payment for the diabetes patients as of early August.
She says it definitely was worth the time and effort to par- ticipate in the program. Between just herself and one of her partners, they had roughly 50 qualified patients, which means $5,000 per year in incentive payments, she says. “We’ll submit data again in six months and probably have even more patients who qualify,” she added. During the original pilot of the diabetes program, BCBSTX limited the number of patients for whom a physician could gain incentive payments to 150. The limit has since been lifted.
Bridging the quality chasm BCBSTX began its diabetes recognition program as a pilot in June 2009 and added cardiac care in 2010. Dr. Sanchez says the carrier decided to partner with Bridges to Excellence be- cause of the potential for higher quality care and lower cost. “What Bridges to Excellence [BTE] brought to us was a very,
very compelling story about how, when doctors were identified as being BTE adherent and, therefore, getting BTE recognition, they were delivering better quality care in terms of nationally recognized, agreed-upon metrics,” he said. “These are national standards that clinicians use to practice medicine all across the country, whether it’s rural Texas, urban Texas, or a state outside of Texas.” The Bridges to Excellence standards for diabetes include
measures of hemoglobin A1c, blood pressure, and low-density lipoprotein (LDL) cholesterol control. For example, physi-
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68