Critics say Louisiana proposal to penalize doctors not meeting standards provides wrong type of incentive

A Louisiana Department of Health and Hospitals proposal to implement performance standards for physicians who care for low-income residents has come under criticism from child care advocates who say the program will lead doctors to stop participating in the state's CommunityCARE program, the Baton Rouge Advocate reports.

As of January, about 706,419 state residents were enrolled in the program, 83.75% of whom are children. Through CommunityCARE, qualifying low-income residents can receive no-cost or subsidized health coverage. Under the DHH proposal, physicians would be evaluated based on measures including how many of their child patients come in for well-visit checkups or how many adult patients get screened for breast or cervical cancer. Many doctors already meet or exceed these standards, according to DHH Secretary Alan Levine.

Doctors participating in CommunityCARE who fail to meet performance milestones would lose the $3 monthly payment for managing patients' care. If no goals are met, the monthly payment would be reduced from $3 to $1. If one goal is met, the payment would be $1.50, $2 if two are met and $3 if three are met. The $3 is in addition to reimbursements doctors receive for care delivered. Levine said, "We are trying to basically improve the performance of those performing poorly and get better health for patients." He said that he will post a notice about the proposal in the coming weeks and that the program would begin in January 2010.

The Louisiana Maternal and Child Health Coalition says the state should create incentives for better care by paying more rather than cutting reimbursements, which the group says are already insufficient, according to LMCHC staffer Sandra Adams. She said, "It is another cut in pay for doctors," noting that they already stand to lose 7% of Medicaid reimbursements for services delivered. She predicted an "exodus of doctors" from CommunityCARE, adding, "Every time you put up a barrier like that, doctors say, 'I've had enough. It's time to walk'" (Shuler, Baton Rouge Advocate, 4/2).