Quality measures in dermatology

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deltamed

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I've yet to see a measure that is actually useful and meaningful.

Since all the new payment rules are going to link payment to "quality" and "outcomes" has anyone seen an actually fair and well-thought-out measure that isn't easily abused or that will not create perverse incentives?

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It's tricky in dermatology.

Our group is banking on "patient satisfaction" as the metric

That would be nice but I think the direction things are going it will be more punitive than that.

I've heard we'll be "penalized" if patients are seen too often (ie each patient only gets 1 visit a year and additional visits incur quality penalties). I've also heard reimbursement will be based on diagnosis codes. Ie, you found a BCC on the cheek? We'll give you $350 for that- doesnt matter if you ED&C, excise or mohs. And if it recurs again you get nothing.... Choice is yours.
 
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That would be nice but I think the direction things are going it will be more punitive than that.

I've heard we'll be "penalized" if patients are seen too often (ie each patient only gets 1 visit a year and additional visits incur quality penalties). I've also heard reimbursement will be based on diagnosis codes. Ie, you found a BCC on the cheek? We'll give you $350 for that- doesnt matter if you ED&C, excise or mohs. And if it recurs again you get nothing.... Choice is yours.

I'm sure they would love to do this capitated / risk transference payment model but I'm having a very hard time seeing it fly. I very much believe you will soon be stratified in accordance to piss poor cost metrics, though. Number of visits per year, number of procedures per encounter, flap/graft:complex:intermediate repair ratios, Mohs on the trunk, number of stages, frequency and number of special stains, total number of encounters per year, etc. These starry eyed Soviets believe that everyone should be tightly grouped statistically and if your referral only square peg Mohs practice does not neatly fit in the hole made for the median general dermatologist...well then, they'll just use a bigger hammer and make you fit.
 
I'm sure they would love to do this capitated / risk transference payment model but I'm having a very hard time seeing it fly. I very much believe you will soon be stratified in accordance to piss poor cost metrics, though. Number of visits per year, number of procedures per encounter, flap/graft:complex:intermediate repair ratios, Mohs on the trunk, number of stages, frequency and number of special stains, total number of encounters per year, etc. These starry eyed Soviets believe that everyone should be tightly grouped statistically and if your referral only square peg Mohs practice does not neatly fit in the hole made for the median general dermatologist...well then, they'll just use a bigger hammer and make you fit.

I think unfortunately it's only a matter of time before it will happen. It's already happened for hospital based medicine- they pay for admission diagnoses - ie you have a patient with pneumonia, we give you X dollars and it's up to the doctors and system to make that work.

Medicare has stated flat out that they are looking to eventually end fee-for-service:
http://www.hhs.gov/about/news/2015/...care-reimbursements-from-volume-to-value.html

I'm not sure how this will play out in dermatology but it cant be good. I can easily see them, especially with the more specific ICD10 codes shifting to diagnosis-based reimbursement.
 
I think unfortunately it's only a matter of time before it will happen. It's already happened for hospital based medicine- they pay for admission diagnoses - ie you have a patient with pneumonia, we give you X dollars and it's up to the doctors and system to make that work.

Medicare has stated flat out that they are looking to eventually end fee-for-service:
http://www.hhs.gov/about/news/2015/...care-reimbursements-from-volume-to-value.html

I'm not sure how this will play out in dermatology but it cant be good. I can easily see them, especially with the more specific ICD10 codes shifting to diagnosis-based reimbursement.

I'm pretty much a cynic myself, but I would not bet on them nuking the current system completely just yet. They have had DRG based payment for hospitals since the '80's I'm pretty sure and no one (other than the truth allergic hospital execs) are peddling the notion that the hospitals are going broke because of the overall payment paradigm they operate in.

ICD-10 is not that specific for many things, actually, and does not have any form of severity scoring.

Without the prior development of widely accepted quality metrics -- which are much more difficult to assess, much less agree upon that one would believe -- the DRG / value based pay model is dead in the water. Sure, there are limited quality metrics already that are of varying validity and import that they use to extrapolate to measures well beyond their practical limitations, but a wholesale change will be politically more difficult to push through than you've been led to believe.
 
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