PROMETHEUS Payment: Better Quality and a Better Business Case

Frustration with the quality of care provided by the American health care system has motivated a raft of new initiatives throughout the country. Medicare's “voluntary” hospital reporting program to which Congress attached financial penalties for noncooperation,1 the purchasing principles of the Leapfrog Group,2 and the 100,000 Lives Campaign3 are all manifestations of this dissatisfaction. Although these efforts are all intended to improve care, they occur within the context of payment systems that have been decried, particularly by physicians, as unfair, administratively burdensome, and distracting from the ability to deliver optimal care. Pay for performance, which represents a positive change from the “one size fits all” quality approach of most health care payment systems, is at best transitional.4 Even the Institute of Medicine (IOM) has called for a new payment model as an essential feature of a better health care system for the 21st century.5,6 The challenge would be to develop a model that would not only track explicitly to the values articulated by the IOM but also reduce administrative burden to providers and plans and improve quality of care—all in the context of a more transparent, patient-centric environment. Beginning in December 2004, a group of experts in quality, research, economics, healthcare financing, law, and medicine began to meet monthly to design PROMETHEUS Payment: Provider payment Reform for Outcomes, Margins, Evidence, Transparency, Hassle-reduction, Excellence Understandability and Sustainability.7 This commentary describes the salient features of the new model, its specific appeal to cancer care providers, and its potential benefits. Fundamentals The basic...

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Alice G. Gosfield is an attorney in private practice in Philadelphia with Alice G. Gosfield and Associates, PC. She is the first Chairman of the Board of PROMETHEUS Payment Inc., the past Chairman of the Board of the National Committee for Quality Assurance (NCQA) (1998–2002), and a past President of the National Health Lawyers Association (1992–1993). Among her other oncology-related representations, she has been general counsel to the National Comprehensive Cancer Network (NCCN) since 1995.

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    Gosfield AG. In common cause for quality. In: Health Law Handbook 2006 Edition. St. Paul (MN): WestGroup, 2006:177222. Available at: http://www.uft-a.com/PDF/commoncausequalityCh5.pdf.

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    Gosfield AG, Reinertsen JL. In Common Cause for Quality Part 1: New Hospital-Physician Collaborations, Hospitals and Health Networks Online. Available at http://www.hhnmag.com/hhnmag_app/jsp/articledisplay.jsp?dcrpath=HHNMAG/PubsNewsArticle/data/2006October/061010HHN_Online_Gosfield&domain=HHNMAG. Last accessed October 31, 2006.

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