Finally, Someone Else Is Saying It!

There is an article in the Boston Globe entitled Journal Editorial: Pay-for-peformance a faulty police in medicine.  Ya think!  I have been saying this for years.  Yes, years.  I originally called P4P something else and that was Physician Profiling.  And I still believe it.  Here are some highlights from the article:

  • A review of seven studies of primary care programs that paid doctors extra for meeting certain targets, published by the Cochrane Collaboration in September, was inconclusive about the effect on quality of care.
  • A study published in March in the New England Journal of Medicine found that a large Medicare pilot program that paid providers more if they met certain process targets — and docked pay for those who did poorly — did not reduce short-term patient mortality rates.
  • In an editorial published Tuesday in BMJ, formerly known as the British Medical Journal, two public health professors and a best-selling author in the field of behavior economics explain why they think paying doctors more based on quality metrics is inherently problematic.
  • Himmelstein and Woolhandler,long-time advocates for a national health system, state that “Incentives may mutate honesty into legal trickery; gaming can so thoroughly distort reality that rewards become uncoupled from performance”

The only thing they didn’t mention is that nothing will stop the freight train of P4P/Quality Metrics because physicians are not  in charge anymore.   Evidence be damned.


  4 comments for “Finally, Someone Else Is Saying It!

  1. mamadoc
    August 22, 2012 at 9:46 pm

    Just today a Medicare Advantage plan called and wanted a bone density on a patient who just went to the nursing home with a fractured hip. She doesn’t need a bone density, the diagnosis is already made and obvious. She needs those *&&^% to pay for the Forteo I asked for last year so she wouldn’t have had another fracture. But some moron wants a BMD so they can cross it off their list.

  2. August 22, 2012 at 10:14 am

    Once again, I commiserate wtih the poor doc who has to dance to the tune of some ivory tower pinhead who is going to metricize her/him and pay accordingly, regardless of whether that approach is doable or proven.

    This is EXACTLY what has gone on in education since I entered that profession in 1957. Some politician/journalist/whatever (as long as he/she has no experience in education) decides that we should have “merit papy”. It’s all so simple. Give a test and pay teacher according to the results. It’s B.S. in schools, and it’s B.S. for docs.

    • August 27, 2012 at 6:39 pm

      Pat, since gov’t being in charge of industries guarantee that those in charge will not have the necessary expertise, doesn’t this further argue for minimizing the government’s role in health care? I think education is a great parallel, as it to is not a prescribed Constitutional right. Cheers!

  3. CancerDoc
    August 20, 2012 at 7:35 am

    I have been feeling meaningless toward meaningful use. As an oncologist who is seeing patients for specific problems, why should I be asked to document routine health maintenance (that should be done by the primary care provider who sent the patient to me). As an oncologist, if I AM asked to document (and then refer?) for routine health maintenance, where is the button for “not applicable.” If a patient has extensive stage small cell lung cancer at age 65 but has never had a screening mammogram or colonoscopy, to be honest, it just doesn’t make sense from an anticipated life duration perspective to do it. If they want physicians to play the meaningful use game and play P4P, make it meaningful.

    Recently, I have noticed that some of the primary cares in my community are dutifully referring patients for health maintenance studies when….well, patients don’t have a predicted survival to justify the health maintenance. To not send (and therefore save those healthcare dollars) will put them on the wrong side of the performance curve. This is what cookie cutter medicine will do for you, though.

    Data recently came out regarding the payback for readmission rates in 30 days per medicare guidelines. SHOCKER: in general, higher payback in hospitals dealing with lower socioeconomic patients. Yeah! That’s the ticket! Penalize hospitals for trying to take care of a more difficult patient population (I work in a poor socioeconomic area, and to be honest, I have patients that no matter what I do/say the neurons just aren’t going to make that connection).


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