CMS offers an incentive for doctors to use health IT

The Centers for Medicare and Medicaid Services is dangling before some physicians a deal they might not want to refuse.

Among its pilots, CMS aims to help the largest segment of the health care industry'small physician practices, also the most resistant to adopting IT'lower the risk of IT investments. A provision of the Medicare reform law lets CMS help fund IT investments for some small physician offices to jumpstart wider adoption of health care IT, said CMS administrator Mark McClellan.

The agency of the Health and Human Services Department has made a priority of encouraging use of health care IT, and is putting its influence as the nation's biggest health care purchaser behind the effort.

As an incentive to physicians' offices, doctors will receive more payments when they can prove that patient safety and the quality of care have improved in their practices.

"Doctors can do a lot to help keep overall costs down with quality of care. Right now they get no benefits. There is no connection between what they are paid and what the impact is on the overall costs," McClellan said.

CMS has three demonstration projects:

- Large physician group practice demonstration, which pays them for performance based on both quality metrics and efficiency gains. "It's not explicitly tied to IT, but given IT's ability to improve quality, it is presumed that IT is included," said a CMS official, adding, "Large practices tend to have some systems, and by paying for performance it will increase the leverage for more IT systems."

- Medicare Care Management Performance demonstration. CMS envisions paying for both IT investment, care process improvements and for actual achievement of quality of care metrics. It is designed to offset some small-office physicians' costs. "IT will lead to improved performance," the official said.

- Doctors' Office Quality-IT. This is a Quality Improvement Organization study to support small- to midsize physician practices to adopt IT, improve care processes and to report quality measures. The project has no money attached to it but it will provide technical assistance and support for doctors. Some pilots have already started in California with Lumetra, a nonprofit organization based in San Francisco, to which CMS awarded the role of lead QIO. For example, a doctor would go to Lumetra, which will provide education for physicians, to learn how to improve care practices, how to shop intelligently for IT systems and help with implementation, and how to create performance measures and use them for reports.

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