MEDICARE INTIATIVE: PAY FOR PERFORMANCE –

In January of 2005 Medicare -CMS (www.cms.hhs.gov) came out with the Pay for Performance Initiative to help control the escalating costs of healthcare. With growing acceptance, the initiative covers almost every facet of healthcare; from hospitals, nursing homes, rehabilitation centers, physician groups, and insurance payors to diagnostic radiology. This is a collaborative effort with multiple organizations from JCAHO, AMA and others. Simply put, if the centers or groups meet and submit the outlined criteria for the performance guidelines, they will receive the full reimbursement for the facilities Medicare DRG payment schedule.

With this, the American College of Radiology (www.acr.org) has followed suit with their own (though based solely in the CMS initiative) P4P which will reward radiologists (long overdue) - value added compensation- for the superior services that they render. This will cover not only correct reporting, but also the limiting of radiation exposure during CT, Fluoroscopy and Nuclear Medicine. The guidelines must be met in order to receive compensation. In regards to insurance companies, some have also come on board with their own outlines with this initiative. They have stated that during a hospital stay, if the initial diagnosis is missed, the payor will not reimburse the facility and the patient will not be charged for the stay or the diagnostic testing that was done during said stay, though, if the diagnosis is made, the institution will be reimbursed. These are bold moves, but much needed ones. Healthcare spending was and is affecting the economy. Healthcare for most has become a distant memory because they are unable to afford it. It is a shame, that the mightiest country in the world cannot provide adequate healthcare for all at a reasonable cost.