Last month I wrote about Metrics and the fact that many of the currently used pharmacy measures are becoming compressed—the range of scores is rapidly approaching a point where you can do no better.
Today I offer proof in the form of the current pay-for-performance program being run by one national health plan. This pay-for-performance plan is based on a DIR fee that is either partially or fully returned if you achieve scores above the 50th percentile and the 80th percentile in key metrics. Let’s take a look at the first quarter for 2018’s requirements to achieve this performance bonus.
The three metrics here are all PDC (percentage of days covered) compliance measures. In order to meet the minimum requirements and obtain some of the DIR fee back, a pharmacy has to have over 90% of its patients taking their medication appropriately. Let that sink for a moment. Over half of the pharmacies in this plan maintain a patient population that is more than 90% compliant. That is a large number of both patients and pharmacies. But then it becomes absurd. In two of the three measures, a pharmacy can only reach the top 80% of pharmacies if every single patient they have in that plan is compliant.
Now there is a positive side to that absurd statement. It is possible for more than the top 20% of pharmacies to reach the top 80% marker But if that happened I would imagine that the scoring rubric would be modified.
“…if everyone is super, no-one is.” – Syndrome from The Incredibles.
So the compression of metrics that I have predicted for the past two years has actually already happened. It shows that there are a lot of pharmacies and pharmacists making every encounter count. Unfortunately, the result is a little depressing as more and more pharmacies are not being rewarded for otherwise stellar performance.