Consumer Advocates Question MCOs Practice of Offering Providers Bonuses to Provide ‘Quality’ Care

Long "reviled" by some consumers for "paying bonuses" to doctors who "engage in ... cost-cutting practices," managed care companies have shifted to a "new tactic" -- awarding doctors bonuses for following "best practices" guidelines designed to improve the quality of care, the Washington Post reports. The best practice guidelines, sometimes called "evidence-based medicine," include a number of preventive measures, such as providing patients with regular mammograms and immunizations and ensuring proper care for chronic conditions. Managed care executives hope that offering bonuses for following the guidelines, rather than resorting to "exhortations," will "persuade" doctors to follow them. "The managed care movement has always looked for incentives to improve care, and right now doctors typically get the same amount of money" regardless of the quality of care they provide, according to Dennis Horrigan, a vice president at the Independent Health Association of Buffalo, which offers annual bonuses of up to $18,000 to some primary care doctors. Other health plans have offered similar bonuses, including Anthem, which awards $15,000 bonuses to New Hampshire providers, and Aetna U.S. Healthcare, which provides 60% of its 100,000 primary care doctors with a monetary "enhancement." According to Mary Beth Fiske, a health care consultant with the Robert Wood Johnson Foundation, most plans use "patient satisfaction data" and guidelines known as the Health Plan Employer Data and Information Set to establish bonus criteria. However, offering bonuses to doctors to "do what they're supposed to" concerns many health advocates. "These (bonuses) drive me nuts," Charles Inlander, executive director of the Peoples' Medical Society, a Pennsylvania advocacy group, said, adding, "To me, meeting HEDIS is the minimum standard -- not the end of the line in terms of quality. We should pay people who aren't meeting them less, or kick them out of a plan" (Boodman, Washington Post, 7/3).