Pay for Performance

[Anasazi23]

What do you all think of this pay-for-performance stuff?
The monetary incentives would have to be pretty great for me to consider this in my practice. Getting a patient better isn't like replacing a muffler. There shouldn't be "money-back guarantees."

Then again, it's Medicaid and Medicare, so maybe I shouldn't get upset.

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[OldPsychDoc]

What do you all think of this pay-for-performance stuff?
The monetary incentives would have to be pretty great for me to consider this in my practice. Getting a patient better isn't like replacing a muffler. There shouldn't be "money-back guarantees."

Then again, it's Medicaid and Medicare, so maybe I shouldn't get upset.

Sazi, like it or not, it's a fact of life--and unless you're going to be one of the many physicians competing for a very few private-pay fee-for-service patients, it will be a mandated part of your practice. We're in the middle of deciding exactly how this will be measured and rewarded in our system--it's not going to be a huge payout no matter what. Looks like just one more thing that has to be tracked, along with all the other bureaucratic costs of medicine. So my advice is, "just turn your head and cough"...

 

[Anasazi23]

I'm not sure I understand this whole thing. The article insinuates that there will somehow be scales that rate quantitatively how much our patients improve...and then our payout from medicare/medicaid is based on that?

Or have I got it wrong?

 

[Poety]

Sazi, like it or not, it's a fact of life--and unless you're going to be one of the many physicians competing for a very few private-pay fee-for-service patients, it will be a mandated part of your practice. We're in the middle of deciding exactly how this will be measured and rewarded in our system--it's not going to be a huge payout no matter what. Looks like just one more thing that has to be tracked, along with all the other bureaucratic costs of medicine. So my advice is, "just turn your head and cough"...

Sazi, OPD - will this end up being like documentation of patient improvement with reviews to manage quality/improvement? (Oh please say no, I can't imagine more paperwork!) And what about patients that are SPMI? They usually don't get much improvement in which case management would be more of the issue. When do you see something like this going into effect OPD?

 

[Hurricane]

If the goal is to come up with a standardized way to rate physicians - which boils their effectiveness down to a percentage of patients with "satisfactory outcomes" - then doesn't that penalize physicians for taking the most difficult and refractory cases? So when deciding whether to take a new patient, you'd have to try to balance "easy" patients with "hard" patients to keep your stats up? That doesn't sound good. This is medicine, not baseball...

 

[Miklos]

Double post, please ignore.

 

[Miklos]

If the goal is to come up with a standardized way to rate physicians - which boils their effectiveness down to a percentage of patients with "satisfactory outcomes" - then doesn't that penalize physicians for taking the most difficult and refractory cases? So then you'd try and balance "easy" patients with "hard" patients to keep your stats up? That doesn't sound good. This is medicine, not baseball...

My thoughts exactly.

It may have the perverse effect of giving worse care to the most difficult cases, while showering the "worried well" with attention.

Don't surgeons already play this game by not taking on geriatrics, etc. in order to improve their outcomes?

 

[OldPsychDoc]

Sazi, OPD - will this end up being like documentation of patient improvement with reviews to manage quality/improvement? (Oh please say no, I can't imagine more paperwork!) And what about patients that are SPMI? They usually don't get much improvement in which case management would be more of the issue. When do you see something like this going into effect OPD?

Unfortunately, that's basically what it is--so just as "no child left behind" leads to testing and definitions of educational competency based on numerical test scores, "P4P" will reduce patient care "quality" to numbers on satisfaction surveys and the like. We are being mandated by our group to institute some of these measures in 2006--so get used to it, it will be one more well-intentioned thing, like JHACO and HIPPA, that will expand to fill your time with compliance standards and documentation.