"Transparency", or, the emperor has no clothes....

Government Health IT has an article this week on Medicare's new incentive program for quality reporting ("Quality movement gets boost from Congress"). It describes legislation signed into law in December that will give a 1.5% bonus to Medicare providers who agree to give quality data to the government. This isn't quite P4P, because physicians get the bonus simply for submitting the data, regardless of what the data might show.

This is Medicare's third foray into this type of data collection. The first was DOQ-IT, which provided free EHR implementation consultations to physicians who agreed to give quality data to Medicare. Second, was the Physician Voluntary Reporting System.

Neither of these earlier efforts have made any notable headway on the data collection front. DOQ-IT has spent years trying to create the data collection infrastructure with little, if any, real success (though DOQ-IT's EHR implementation support program has done well and is quite good). And as for the Physician Voluntary Reporting System, well, the name says it all.

This new 1.5% bonus is barely a step above a voluntary system. Since Medicare accounts for about 16% of the insurance market nationally (95% for over-65s), the return to the "average" doc would get diluted down from 1.5% to 0.2%. I have yet to meet a physician who hasn't already done this math in his or her head and decided that it's just not worth it.

All of this has a corrosive effect on the health IT movement. It undercuts those of us who have been arguing that you can't have meaningful P4P without health IT, and you won't get health IT without P4P -- after all, if health IT and P4P really are valuable, wouldn't the biggest payer in the country invest real money in them?

The federal government has put shockingly little money into health IT to date (Blue Cross Blue Shield of Massachusetts has invested more in EHRs than the federal government has). We won't see real progress in health IT at the national level until Medicare puts real incentives and real money into play, because they have a lot of funding and, more important, when they do it others will fall in line.

The latest healthcare catch-phrase from the federal government is "transparency". Unfortunately, the logic behind Medicare's approach to P4P and health IT couldn't be more opaque.....