The P4P Fallacy Continues

You are not going to believe this but even the New York Times is against the Pay-for-Performance trend that is ruining our healthcare system. I wish the author, Bill Keller, knew more about what he was talking about, though.  He should have contacted me if he wanted to spice up his  article.   Alas, he did not so here are some the highlights he points out:

  • The logic seems unassailable: Reward quality, and you will get quality. Stop rewarding waste, and you will get less waste. QED! P4P!  If only it worked.
  • In practice, pay for performance does little to improve outcomes or to control costs.
  • But the pay-for-performance provisions are a triumph of theory over experience.
  • Another problem with P4P is that providers learn how to manipulate the results.

I didn’t highlight much more because much of what he states is total horeshit and shows how little he knows comprehends our medical system.  Highlights of this include the following (with my comments in parenthesis):

  • But if you look hard enough at why this common-sense approach doesn’t deliver, you find some clues to what might (Really?  Studies show differently but this sleuth has somehow found the answers. Not.).
  • The main problem is that our system charges far more for each service (He does not go into detail on where our money is going).
  • But the main reason everything costs less in other countries is that other countries tend to have one big payer — usually the government — with the clout to bargain down prices (Bureaucracy is where the money is going now.  This includes the insurers, the administrators and the government.  This is not solved with more government which has NEVER shown to bring down prices for anything).
  • As hospitals merge into mightier megachains, they may be able to bargain down the payments to doctors and drug companies and device-makers, and create economies of scale by standardizing treatments (Dude, those Megachains save the money for their shareholders and administrators!  You are so clueless).
  • PETER PRONOVOST, a physician and professor at Johns Hopkins, says that rather than bribe doctors to adopt better practices, we should play to doctors’ professionalism (Sorry.  I can’t comment because I can’t stop laughing).
  • Pronovost has a more radical piece of common sense to offer. He proposes that the United States create an agency that would do for medicine what the Securities and Exchange Commission does for securities markets: compile and audit information about the performance of hospitals, and make it public. (Yeah, that is what we need.  Another government agency.  Looks like this Ivory Tower douche needs to start seeing real patients again).

Beggars can’t be choosers.  I am stoked that the NYT at least addressed this bogus trend which the government and insurers have unfortunately forced upon doctors.   I won’t point out my fixes yet because I  will need so many more blogs in the future to do that.  🙂

28620cookie-checkThe P4P Fallacy Continues