There are several pay for performance opportunities for clinicians. Pay for performance offers a quality incentive based on money saved. Improved quality means less litigation and pay for performance offers increased clarity about what is reimbursed. In addition, there is also feedback about clinical outcomes, which allows learning and improves outcomes. Pay for performance leads to increased consistency of care between both between clinicians and across settings.
In preparing for pay for performance in wound care and ensuring appropriate treatment of patients at risk for developing a wound, one should emphasize the following:
• consistent evaluation and treatment plans;
• disease management to lower chronic wound risk;
• consistent measurement and reporting of outcomes; and
• consistent documentation of care;
For patients with wounds, one should:
• stop causes of pain and tissue deterioration;
• optimize the healing environment
• reduce pain and infection (associated with gauze use); and
• remove devitalized tissue which can be an infection focus.
Physician payment is about to undergo a paradigm shift. While dramatic changes like this are difficult, pay for performance represents an opportunity for clinicians to improve patient care.
Dr. Fife is an Associate Professor in the Department of Anesthesiology at the University of Texas Health Science Center in Houston. She is the Director of Clinical Research at the Memorial Hermann Center for Wound Care. She is also the President of Intellicure, a wound specific EMR provider.
Dr. Steinberg (pictured at left) is an Assistant Professor in the Department of Plastic Surgery at the Georgetown University School of Medicine in Washington, D.C.
1. Siwicki B. Outpatient electronic records. Tackling the challenges. Health Data Management, May 1997, 5: 66-68, 70, 74, 76-78, 81.
2. Khoury A. Support of Quality and Business Goals by an Ambulatory Automated Medical Record System in Kaiser Permanente of Ohio. Effective Clinical Practice, October/November 1998, 1: 73-82.
3. CPRI Workgroup. Valuing CPR Systems: A Business Planning Methodology. Schaumburg, IL: Computer-based Patient Record Institute, 1997.
4. HIMSS Electronic Health Record Definitional Model Version 1.0 2004.
5. Adult diabetes: percentage of smokers who were recommended or offered an intervention for smoking cessation (i.e., counseling or pharmacologic therapy). National Diabetes Quality Improvement Alliance 2003 May. NQMC:000616. Accessed at www.qualitymeasures.ahrq.gov.
6. Adult diabetes: percentage of patients receiving at least one complete foot examination (visual inspection, sensory exam with monofilament, and pulse exam). National Diabetes Quality Improvement Alliance 2003 May. NQMC:000610. Accessed at www.qualitymeasures.ahrq.gov.
7. Adult diabetes: percentage of patients receiving one or more A1c test(s). National Diabetes Quality Improvement Alliance 2003 May. NQMC:000596. Accessed at www.qualitymeasures.ahrq.gov.