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.