Pay for Performance - Misnomer?

[filter07]

One of the big things in surgery is pay for performance. Preop antibiotics, GI prophylaxis, oral care in the ICU, etc. They call this pay for performance, and the government is big on this initiative. I know many surgeons are enthusiastic about this, thinking that these measures will somehow increase reimbursement.

But isn't this just a way of DENYING reimbursement for not doing whatever the bureaucrats want us to do? What if one day the politicos decide we need to give everyone an awesome haircut before they get discharged from the hospital, or they won't pay for a CABG? Wouldn't this just add more complexity and confusion to an already unwieldy reimbursement formula?

Why are surgeons so enthusiastic about this? A one time "increase" in pay for good performance will eventually be offset by the annual decrease in reimbursement. After a year or two, these "gains" will be erased, and we'll have to do a bunch of extra junk to patients just to keep salaries at what they were several years ago. In the long run, all this does is increase government red tape while not having much effect on reimbursement.

We don't need more government interference in medicine! We don't need complex formulas that won't really differentiate between good or bad performance. What we need is for the government to stay out of our pockets and out of the business of healthcare reimbursement. Every single time the government has increased their presence in healthcare, they made it suck more!

Isn't it time for doctors to stop begging at the feet of the suits, and stop doing our silly monkey dance for them? I think pay for performance should be abandoned.

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[StevenRF]

I spent my summer doing an internship doing nothing but analyzing P4P data for the hospital... its generally crap all around. It has nothing doing to do with increasing reimbursement what so ever. Right now the metrics are payed based meeting such an such percentage of patients in its preliminary phase. It's going to transition to percentiles where only the top X percentile of hospitals get the bonus while the rest are withheld. The spreads for some of these metrics are already approaching everyone being above 90%. That doesn't even scratch the surface... some studies are coming out showing P4P has no added effect on outcomes compared to just making sure physicians are informed. Or being able to try and measure "quality of care" with some simple data point like giving aspirin or immunizations.

The system is already starting to be gamed as well. Those hospitals with superior IT systems for notifying physicians at time of data entry and those with nursing staff specifically for policing just these metrics are reaping the benefit. The problem is those hospitals that need the money most can't afford these.

I also spent a lot of time this summer on contract negotiations (By the way, if you saw how these were done you would **** yourself like you had UC). The MCO's are already trying to supplant parts of the FFS and capitation rates for P4P payments. The next step is going to be making these ratings on hospitals/physicians public. Eventually there will be subjective ratings by patients on their experience.

In the mean time, make sure you tell your patients "smoking's bad M'kay" before having them sign the form saying you informed them about smoking prevention. Show me the money...

 

[Faebinder]

One of the big things in surgery is pay for performance. Preop antibiotics, GI prophylaxis, oral care in the ICU, etc. They call this pay for performance, and the government is big on this initiative. I know many surgeons are enthusiastic about this, thinking that these measures will somehow increase reimbursement.

But isn't this just a way of DENYING reimbursement for not doing whatever the bureaucrats want us to do? What if one day the politicos decide we need to give everyone an awesome haircut before they get discharged from the hospital, or they won't pay for a CABG? Wouldn't this just add more complexity and confusion to an already unwieldy reimbursement formula?

Why are surgeons so enthusiastic about this? A one time "increase" in pay for good performance will eventually be offset by the annual decrease in reimbursement. After a year or two, these "gains" will be erased, and we'll have to do a bunch of extra junk to patients just to keep salaries at what they were several years ago. In the long run, all this does is increase government red tape while not having much effect on reimbursement.

We don't need more government interference in medicine! We don't need complex formulas that won't really differentiate between good or bad performance. What we need is for the government to stay out of our pockets and out of the business of healthcare reimbursement. Every single time the government has increased their presence in healthcare, they made it suck more!

Isn't it time for doctors to stop begging at the feet of the suits, and stop doing our silly monkey dance for them? I think pay for performance should be abandoned.

I dont think surgeons are excited about pay for performance... only primary care is excited about it. We all know the true agenda. Pay private institutions less of medicare/insurance money cause they are "less" quality.

 

[Faebinder]

Seriously, the correct way surgeons can fight all this is really simple.

1) Truly remove emergencies from being emergent into urgent. I.E. Is an appendicitis emergent or urgent. Does it need to be taken out at 2 am or can it wait till 8 am? Once this is established, we will start seeing more force towards paying for cases instead of simply going to the ER and expecting the appendix to be removed for free cause of EMTALA.

2) Start establishing more mini surgi centers. Now that you moved many cases from emergent to urgent, many cases can sit and wait. Meanwhile, mini surgical centers run by surgeons and anesthesiologist will evade the need to go to hospitals. The only problem is that many will elect to go to the ER and wait for their surgeries to get done. That's fine, the surgeons covering the ER will let them sit and wait since they are probably soooo booked. If they want to get their appendix taken out now then there is that surgi center nearby. In and Out the same day.

Just move everything to outpatient for the minor cases (lap cholecystectomies, lap appies, lap nissens, lap bands). Any patient who needs to stay overnight can be admitted to a hospital. The hospital is just a large surgi center with an overnight staying unit pretty much.

 

[sleeping]

Seriously, the correct way surgeons can fight all this is really simple.

1) Truly remove emergencies from being emergent into urgent. I.E. Is an appendicitis emergent or urgent. Does it need to be taken out at 2 am or can it wait till 8 am? Once this is established, we will start seeing more force towards paying for cases instead of simply going to the ER and expecting the appendix to be removed for free cause of EMTALA.

2) Start establishing more mini surgi centers. Now that you moved many cases from emergent to urgent, many cases can sit and wait. Meanwhile, mini surgical centers run by surgeons and anesthesiologist will evade the need to go to hospitals. The only problem is that many will elect to go to the ER and wait for their surgeries to get done. That's fine, the surgeons covering the ER will let them sit and wait since they are probably soooo booked. If they want to get their appendix taken out now then there is that surgi center nearby. In and Out the same day.

Just move everything to outpatient for the minor cases (lap cholecystectomies, lap appies, lap nissens, lap bands). Any patient who needs to stay overnight can be admitted to a hospital. The hospital is just a large surgi center with an overnight staying unit pretty much.

1. Classify emergent vs. Urgent is a good idea. You will need a lot of studies to prove equivalence.

2. Mini-surg centers are pretty expensive. You initially need a very large investment to open one up.

3. I think we have jumped off the cliff already; no going back. Get ready for more and more pain.