http://bmj.com/cgi/content/full/323/7305/129/a
BMJ 2001;323:129 ( 21 July )
News roundup
Blue Cross to reward doctors for patients' satisfaction
Fred Charatan Florida
Blue Cross of California, one of the United States's largest health
maintenance organisations, with 2.2 million members, has become the first
commercial health maintenance organisation to pay bonuses to its 20 000 doctors
on the basis of patients' satisfaction and other quality standards, instead of
only rewarding doctors who cut costs.
In the past, most health maintenance organisations paid bonuses to doctors
who were able to keep medical costs down compared with their peers. Critics
claimed that such bonuses encouraged doctors to skimp on patient care.
Blue Cross of California will eliminate bonuses based on cost containment.
Instead, it will begin rewarding doctors for patients' satisfaction. It will
survey patients, monitor their grievances, and interview patients when they
switch doctors to determine why.
The new system will also reward doctors who use preventive healthcare
measures—including screening for breast and cervical cancer and programmes to
help patients with asthma and heart disease—and who are successful in
persuading patients to stop smoking.
The bonuses will be up to 10% of the monthly capitation fee that Californian
health plans typically pay their doctors for each enrolled member.
However, healthcare industry watchdogs were sceptical of the move, which
comes amid congressional debate over the patients’ bill of rights. Dr Sidney
Wolfe, director of the health research group of Public Citizen (a Washington
based, non-profit making consumers group), said that he doubted if Blue Cross
of California’s policy change was more than cosmetic.
He believed that in the profit making health maintenance organisations,
fiduciary responsibility to stockholders outweighed good intentions to reward
doctors for satisfying patients and enhancing the quality of health care.
A spokesman for Blue Cross said that competition prompted the new policy,
which is not expected to cost more. "We believe that if you promote
improving the quality of the care . . . and patient outcomes, that will result
in cost effective care," said Dr Robert Crocker, a senior vice president
of Blue Cross.
Pacific Business Group on Health, a coalition that represents California’s
major employers on healthcare issues, hailed the organisation’s move as a step
towards more transparency and better incentives for the industry.
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