A unique physician “pay-for-performance” program at
Montefiore Medical Center has reduced blood sugar and cholesterol levels
significantly among many of the patients in South Bronx.
Physicians in each of Montefiore Medical Group’s (MMG) 21
community-based centers are given targets to reach for blood sugar and
cholesterol levels in their diabetes patients and can be rewarded up to $3,200
annually for attaining these targets, an incentive paid for by the MMG
administration.
“To improve blood sugar and cholesterol in diabetes patients
requires a lot of invisible work, follow-up phone calls, counseling, developing
rapport with patients and staying on their case over time,” said Sophia Au, MD,
an internal medicine specialist in the Montefiore Medical Group for 13 years.
She says it takes about two months to bring sugar levels down considerably for
most diabetes patients through diet, exercise, medications, and home
self-monitoring with a glucometer.
“Physicians are not paid for follow-up care; but, if we
don’t follow-up, we will not succeed and more importantly neither will our
patients. The incentive pay, while not much, is recognition of the invisible
care and doing the right thing,” said Au. “There is another incentive. Because
each physician has formalized scores for her patients, and we share these
scores, I want to be in the top tier among my peers. I am competitive and being
in the top tier is a professional reward.”
“Outcome-based medicine, with comparison scores and monetary
incentives, works in this setting where we care for 14,000 diabetes patients,”
said Arthur Hopkins, MD, medical director of Montefiore Medical Group 1. “We
have been able to keep one standard measure of blood sugar, called HbA1C, below
a recognized level of 9 in 85% of our patients, who have some of the most
severe diabetes in the nation. Other programs caring for the same population of
diabetes patients in the Bronx – e.g. HIP and Oxford have kept HbA1C levels
below 9 for only 67-75% of their patients.” (Data from a state report titled
“2006 New York State Managed Care Plan Performance”). Dr. Hopkins noted that
54% of patients under care at MMG had HbA1C levels under 7.
