Pay for performance

[Awesome Sauceome]

An article in the NEJM on a 10 year study done in the UK on pay for performance pay scales on physicians and patient outcomes. Table 2 at the bottom really sums everything up.
http://www.nejm.org/doi/full/10.1056/NEJMhpr1316051?query=featured_home

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[dyspareunia]

Good thing I'm a subscriber.

 

[Awesome Sauceome]

Aww shoot, I didnt even realize it. I am at my computer at work, at a medical school...

 

[NontradCA]

Aww shoot, I didnt even realize it. I am at my computer at work, at a medical school...

Sum it up?

 

[Awesome Sauceome]

It was a 10 year study on all primary care docs in the UK on pay for performance. The country made it so that 25% of primary care doctors pay came from performance. They found basically that it does not work. Anything over 10% of the pay and the docs start doing things that are not clinically important but result in higher pay. Another major result was that it actually ended up causing longer waiting periods for a patient to see a doctor.

They ended by saying that pay for performance is good up to 10%, in which case it acts as a modest bonus which does help stimulate docs to work in ways that may be more efficient or conducive to better treatment for the patient. Anything over that and it gets sketchy. They suggest that in the future that physicians pay should come from a multitude of sources, with pay for performance as a small but important part.

I just think it was a nice report seeing as us here in the states are working on moving over to quality based payment systems. I think its important to look at longitudinal studies such as this before we really start making a mess.

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[Trannie]

An article in the NEJM on a 10 year study done in the UK on pay for performance pay scales on physicians and patient outcomes. Table 2 at the bottom really sums everything up.
http://www.nejm.org/doi/full/10.1056/NEJMhpr1316051?query=featured_home

If only our medical system was revamped....

 

[dyspareunia]

It was a 10 year study on all primary care docs in the UK on pay for performance. The country made it so that 25% of primary care doctors pay came from performance. They found basically that it does not work. Anything over 10% of the pay and the docs start doing things that are not clinically important but result in higher pay. Another major result was that it actually ended up causing longer waiting periods for a patient to see a doctor.

They ended by saying that pay for performance is good up to 10%, in which case it acts as a modest bonus which does help stimulate docs to work in ways that may be more efficient or conducive to better treatment for the patient. Anything over that and it gets sketchy. They suggest that in the future that physicians pay should come from a multitude of sources, with pay for performance as a small but important part.

I just think it was a nice report seeing as us here in the states are working on moving over to quality based payment systems. I think its important to look at longitudinal studies such as this before we really start making a mess.

Sent from my RM-917_nam_usa_100 using Tapatalk

And how was performance measured? Patient satisfaction?

Patients don't know a damn thing.

 

[Trannie]

And how was performance measured? Patient satisfaction?

Patients don't know a damn thing.

Patients are what drive business. If patients are not happy, there's no $$$ for executives to play with.

 

[dyspareunia]

Patients are what drive business. If patients are not happy, there's no $$$ for executives to play with.

No, supply and demand drive business. If a patient needs a hip replacement and there's only one ortho group in town that accepts the patient's form of insurance, then the patient has no choice even if they hate everyone in that ortho group.

Physicians aren't waitresses working for tips. You provide a service and get paid for doing your job well. Making the patient happy is important too, but the patient's happiness shouldn't determine whether or not you get paid the full amount.

 

[Awesome Sauceome]

And how was performance measured? Patient satisfaction?

Patients don't know a damn thing.

Well and that was some of the problem they also ran into. Which is another reason why they suggest that quality based payments should only be a small part of clinician's pay. They noticed that the physicians began doing things to streamline making the patient happy and receiving good scores, that while not necessarily hurt the patient, did nothing to actually change patient outcomes.

 

[da Vincis World]

No, supply and demand drive business. If a patient needs a hip replacement and there's only one ortho group in town that accepts the patient's form of insurance, then the patient has no choice even if they hate everyone in that ortho group.

Physicians aren't waitresses working for tips. You provide a service and get paid for doing your job well. Making the patient happy is important too, but the patient's happiness shouldn't determine whether or not you get paid the full amount.

Patient satisfaction surveys will be a part of how well you are reimbursed......we are a lot closer to "waitresses working for tips" than you think.