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Neurologists dismayed by decreasing Medicare reimbursement may be interested in a new 1.5 percent payment bonus for physicians who report on quality measures.

The incentive was written into legislation passed by Congress in December to block a scheduled 5 percent cut to Medicare payments. To receive the additional payment, for the second half of the year, physicians will have to report on their compliance with at least three performance measures that have been created in consultation with medical societies and approved by the government.

Medicare officials have been advocating for a pay-for-performance system as a way to curb escalating costs. Basically, physicians who follow specific predetermined quality-of-care measures would receive the bonus from Medicare.

So far, the only published performance measures that specifically pertain to neurology are eight stroke indicators introduced in September. One, for example, asks physicians to indicate whether patients with ischemic stroke were considered for treatment with tissue plasminogen activator (t-PA) within three hours of symptom onset. But the Academy also helped work on two additional measures that are meant to help physicians prevent patients from falling and injuring themselves, said James P. Stevens, MD, chair of the AAN's Pay-for-Performance Work Group. Among its 2007 goals for patient safety, the Joint Commission on Accreditation of Healthcare Organizations cited the need for programs that reduce patient injuries from falls. The Academy is also in the process of creating indicators for epilepsy, multiple sclerosis, and Parkinson disease.

Dr. Stevens cautioned though that the bonus may not be worth the extra administrative costs needed to report quality care. Physicians who use electronic medical records might be able to use software programs to add performance measures to their claim forms. But for physicians who still rely on paper, “it might be expensive to change the way they send in their bills,” Dr. Stevens said. “They may simply say it's not worth it at this time.”