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Pay-for-Performance Doesn't Shortchange Patients

VA study found those with complicated conditions still received high-quality care

WEDNESDAY, June 3 (HealthDay News) -- A new study on pay-for-performance medical care should reassure patients and the doctors who treat them.

"On the patient side, there is concern that patients whose condition is complex may not get the high-quality care that they need," explained study author Dr. Laura Peterson. "Doctors are concerned that under pay-for-performance there may be incentives to avoid patients who are very sick, because it takes time to be sure all their conditions are treated properly and their ratings on measures of health-care quality may suffer."

Surprisingly, the study findings showed just the opposite.

Among the 141,609 people treated for high blood pressure at eight Veterans Administration centers, the researchers found that those whose cases were complicated by other medical conditions were more likely to receive better care than those who only had high blood pressure, said Petersen, who is director of the VA Health Services Research and Development Center of Excellence and an associate professor of medicine at Baylor College of Medicine in Houston.

"We looked at two different ways that medical care is graded, data from medical charts and also patients' ratings of their care, whether they were more or less satisfied," Petersen said. "We did not find that patients who had multiple conditions had less satisfactory medical care than those who did not."

For the patients in the study, "the concern is that the time spent treating other conditions would take away time from treating high blood pressure, causing performance on measures of quality to suffer," Petersen said. "However, we did not find that to be the case."

In fact, the study found that veterans with high blood pressure and additional conditions were more likely to get high-quality medical care, she said. The report was published online June 1 in Circulation.

That finding should also "be reassuring to doctors who are concerned that their efforts to manage patients who have a lot of complex conditions would be at a handicap under pay-for-performance," she said.

But the finding does not necessarily apply to all people treated in all medical centers, Petersen cautioned. "The Veterans Administration has a lot of special systems in place to improve the quality of medical care," she said. "It has excellent electronic medical records and systems to report on the quality of care."

Many medical centers don't have such systems, she said, but "the VA could serve as a model for them."

The study does speak to the value of electronic medical records, said Dr. Vincent J. Bufalino, president and chief executive officer of Midwest Heart Specialists, a 50-physician cardiology group in suburban Chicago that has such a system.

"It makes you better because you don't have to read anyone's handwriting, including my own," Bufalino said. "It does streamline your ability to take care of these folks."

And the study has meaning for blood pressure treatment strategies, he added. "It says that knowing someone is sick doesn't mean you can't control his blood pressure," Bufalino said. "You can do it with good follow-up in an electronic setting."

The message for physicians is the importance of meeting guidelines for good medical practice, said Bufalino, who sits on the physicians advisory council for Medicare. "We're not going to pay you as much if you don't meet the guidelines," he said.

More information

Recommendations on blood pressure control are made by the American Heart Association.

SOURCES: Laura A. Petersen, M.D., director, Veterans Administration Health Services Research and Development Center of Excellence, and associate professor, medicine, Baylor College of Medicine, Houston; Vincent J. Bufalino, M.D., president and chief executive officer, Midwest Heart Specialists, Naperville, Ill.; June 1, 2009, Circulation online

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