Quality and Pay-for-Performance Does NOT Work!


For 13 years I have been saying that this Pay-for-Performance and Quality Metric trend was a scam.  It turns out I will keep saying it. Here is a great article in Modern Healthcare.  Please read it.  The ONLY ones left who believe in this crap are administrators.  Here are some highlights from the piece that you can chew on:

  • Linking financial rewards to cost-effective management of patient care or reducing adverse outcomes has not produced the desired results, recent studies show.
  • Poorly aligned monetary motivations can even lead to difficulties with staff recruitment or retention and lead to over-focusing on one specific issue at the peril of other, more important ones.
  • Value-based pay can drive healthy competition, but reliance on metrics that are easy to measure but don’t ultimately boost outcomes is “a clumsy response to fee-for-service.”
  • Advocates of quality incentive pay say the programs have lifted the performance of some physicians and improved collaboration among clinicians. That was the case for Fairview Health Services, which rolled out an ambitious compensation program in 2010 when it tied 40% of clinician pay to performance on a suite of metrics required by state law. Yet even with the promise of more money, the model “didn’t necessarily have an overwhelming impact,” said Valerie Overton, president for quality and innovation at Fairview Medical Group. It’s not that quality did not go up at all, she said. It’s just that it didn’t go up any more than market competitors that had not instituted such a program.
  • The Fairview payment model also was a source of “significant frustration” among staff, said Greene who, along with Overton, was one of the co-authors of the two studies on Fairview’s pay-for-performance effort.
  • In one, some primary-care physicians in New York were eligible to receive up to $200 per patient and up to $100,000 per clinic based on performance on evidence-based heart-care processes and outcome measures. But there were only small improvements despite the financial incentive, according to a 2013 report published in JAMA.
  • A program in which Houston clinics could receive twice the normal financial incentive given by Medicare for achieving cervical cancer screening, mammography and pediatric immunization targets also had little impact. “Despite considerable initial enthusiasm for the use of financial incentives for quality improvement, this study does not support the efficacy of this approach,” wrote the authors of a 2010 study of that program in the Journal of the American Board of Family Medicine.
  • Not surprisingly, when the CMS released its third year of 30-day readmission penalties last fall, quality researchers said that if only 769 of more than 3,370 U.S. hospitals succeeded in avoiding the fines, that program may not be achieving its desired goal of broadly improving quality of care.
  • “There is essentially no evidence that pay-for-performance works, and certainly no evidence that it works as it is being applied to American healthcare right now,” said Dr. Steffie Woolhandler, a professor at the City University of New York’s School of Public Health.
  • The tendency of pay-for-performance to “dangle money” before doctors has side effects. It turns the intrinsic professional and moral obligation of doing the best thing for the patient into a market transaction governed by price, and also requires excessive amounts of documentation and administrative costs. “If clinicians do have extra time, they should be focusing on real improvement and not just checking boxes to make pay-for-performance goals,” she said.

Years ago, I stated that Pay-for-Performance and Quality Measures was code for PHYSICIAN PROFILING.  I still agree with that moniker.  If you are stuck doing this charade then stop.  Fight back. You are helping no one but the administrators who want to get some gold stars from some bogus accrediting firm with four or five letters (PQRS, SHITE, DUMB, etc).  They want those gold stars for their resumes and to be promoted and have more adminibots under them.  Don’t let this happen.


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