Monday, July 17, 2006

Richard Neill: The case against pay for performance

Richard has assembled a diverse set of links on the case gainst P4P: "The result of this thinking is P4P programs that promote physician behaviors that detract from the demonstrably valuable task of balancing complex competing co-morbidities to achieve improved outcomes.".

It reminds me of 'no child left behind'. From a special needs perspective I have mixed feelings. On the one hand testing less capable children makes it harder to ignore them. On the other hand, it creates paradoxical incentives to make them disappear. I think we'll learn similar lessons when we emerge from the other side of P4P.

When I was a real doctor, most of my patients were "special needs". Sure they were diabetic, but that wasn't necessarily their biggest problem -- or even in the top 3. Strange, but true. You dealt with what they were ready to deal with, and negotiated between the physician's priority and the patient's priority.

P4P will happen. It lets payors reduce payments, so it's inevitable. (Surely you were not so naive as to think P4P really meant extra money for doing well, rather than cuts for not doing well?) It will cause good and harm, but in the end I suspect Richard will be proven right.

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