Year: 2006
Resolution Number: 18
Action Taken: No Action
Status:
Author(s): Domenic R. Federico, MD
Sponsor: Domenic R. Federico, MD
On behalf of:
Committee: A (Medical Care Delivery)
Resolved Section(s):
RESOLVED: That if a physician documents the recommendation for treatment required for pay for performance, then the insurance carrier be mandated to reimburse the pay for performance amount even if the patient fails to have the recommended treatment performed.RATIONALE: The Committee believes that the following language already included in the MSMS Guidelines on Pay-for-Performance Programs addresses the intent of the resolution:“Programs should use accurate administrative data as well as data abstracted from medical records when warranted. Physicians should receive credit for tests and services recommended and efforts to improve patient compliance. (Page 5)“Programs must not financially penalize physicians based on factors outside of the physician’s control, such as patient compliance. Programs should reward physician efforts to improve compliance.” (Page 7)
RESOLVED: That if a physician documents the recommendation for treatment required for pay for performance, then the insurance carrier be mandated to reimburse the pay for performance amount even if the patient fails to have the recommended treatment performed.RATIONALE: The Committee believes that the following language already included in the MSMS Guidelines on Pay-for-Performance Programs addresses the intent of the resolution:“Programs should use accurate administrative data as well as data abstracted from medical records when warranted. Physicians should receive credit for tests and services recommended and efforts to improve patient compliance. (Page 5)“Programs must not financially penalize physicians based on factors outside of the physician’s control, such as patient compliance. Programs should reward physician efforts to improve compliance.” (Page 7)
Fiscal Note: NULL
Resolution: View PDF for Pay for Performance: Patient Responsibility