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The System

Extra Care, Extra Money

A Weekly Check on Health Care Costs and Coverage

Tuesday, April 5, 2005; Page HE02

Let's say an asthma attack sends you to the hospital. You get treatment to aid your breathing and you go home.

Here's where the story -- as told by CareFirst BlueCross BlueShield's Jon Shematek -- turns surprising: You "receive a call from your doctor's office saying, 'We heard that you've been in the emergency room; do you want to come in [to] check your medicines [and] see how we can avoid you having to visit the hospital' " again?

What would prompt your doctor to make that call? Money, if nothing else: Under an initiative launched last week, the insurer will give primary care doctors up to $50 annually for each of their CareFirst patients. The idea is to give patients more information about their health needs and to track their conditions more closely. Participating doctors are likely to use the money to spend more time with certain patients and buy new computer systems.

CareFirst plans to involve at least 16,000 of its members in this pilot program. An individual doctor would be eligible to earn up to $20,000 in bonuses in the first year. A five-doctor practice could receive $100,000 extra.

"We're getting a pretty phenomenal level of interest" from doctors interested in the program, said Shematek, CareFirst's medical director for quality improvement.

"Many practices . . . really would love to adopt electronic medical records or electronic prescribing, and it's simply a matter of expense for them," he said. "This is going to give them really enough dollars to make the investment in taking them to the next level."

"What the patient should see once these changes are in place in a medical practice is a physician who is really armed with tools to take care of them well," Shematek said, tools that include systems for reminding at-risk patients to control their blood pressure or cholesterol levels.

Washington Primary Care Physicians is the first Washington-area practice to enroll in the CareFirst program.

"It's certainly an exceedingly generous incentive," said internist Peter Basch, one of seven doctors in the Capitol Hill practice. Basch said the dollars would allow his office to buy $70,000 worth of software that will prompt doctors to focus more intensely on the needs of patients they see often and to contact those they don't see often enough.

Some of the money may also go to doctors for the extra time they devote to patients with conditions such as diabetes, hypertension and asthma. "Patients . . . with chronic illness need more time, and unfortunately in today's environment they're not given more time," said Basch.

Bravo to CareFirst, says Philadelphia internist Marie Savard, an author who promotes greater involvement of patients in health care decision-making.

"This will move us toward getting patients involved," said Savard. "They can't be responsible if they don't have control over anything, and by giving them control, which is what pay for performance will indirectly lead to, we're going to end up with a home run for everyone," she said.

-- Tom Graham

The System welcomes comments from patients, providers, insurers and others about the delivery of health care. While we cannot advocate on behalf of individuals, we are looking for examples of problems and solutions that may direct our reporting. Contact us by U.S. Mail at the address that appears below or by e-mail at thesystem@washpost.com. Do not send original documents.

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