Given both the growth of and the difficult issues surrounding "pay-for-performance" programs, the APA Board of Directors has authorized the Performance Improvement Advisory Group to develop proposed policy on the parameters for and use of these programs by third-party payers.
Pay-for-performance (PFP) programs, which use performance or outcomes measures as a means of determining the amount to be paid for health-care services, have grown rapidly in the private and public health-care sectors. A study published in the Nov. 2, 2006 issue of the New England Journal of Medicine found that more than 50 percent of commercial health maintenance organizations used PFP programs in 2005. That year, there were reportedly over 100 PFP initiatives, a more than threefold increase from 2003. And myriad approaches are taking shape. According to industry observers, PFP is being used differently by various third-party payers for different purposes.
Psychology leaders say the profession must be prepared to confront health plans that design and implement inappropriate PFP programs.
"We must arm ourselves to challenge payers when they use pay for performance to inappropriately limit services or when their profit and economic motives jeopardize the delivery of quality psychological services," says APA Executive Director for Professional Practice Russ Newman, PhD, JD.
He notes that some health professional associations have brought lawsuits against insurers targeting their PFP initiatives.
"If we found ourselves in one of those battles, it would be critical to have APA policy to support our arguments," Newman says.
Medicare recently implemented a 1.5 percent bonus-incentive payment for providers, including psychologists, who report certain quality measures beginning this year. Yet the Centers for Medicare and Medicaid Services (CMS) has no quality indicators for non-physicians. APA is working to influence how CMS establishes and applies measures to the delivery of psychological services. (See "Perennial battles on the Medicare front," March Monitor.)
APA's Performance Improvement Advisory Group consists of psychologists with expertise in the evaluation and measurement of treatment outcomes in a variety of practice settings.
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