Will “Pay for Performance Work in Healthcare?” Times Editor has Doubts. Here’s Why. —NY Times

Pay-for-Performance Provisions are a “Triumph of Theory Over Experience,” Writes Bill Keller in “Carrots for Doctors.”   

“Pay for performance, or P4P in the jargon, is embraced by right and left. It has long been the favorite egghead prescription for our absurdly overpriced, underperforming health care system. The logic  . . .  If only it worked,” writes former New York Times executive editor Bill Keller, here writing for the Times’ opinion page.  More:

If you spend a little time with the P4P skeptics — a data-bearing minority among physicians and health economists — you will come away full of doubts. In practice, pay for performance does little to improve outcomes or to control costs. But if you look hard enough at why this common-sense approach doesn’t deliver, you find some clues to what might.

. . . The first problem with P4P is that it does not address the biggest problem. Americans spend more than twice as much per capita as other developed countries on health care — a crippling 18 percent of the country’s economic output, and growing. Before studying the statistics, I assumed the root of the problem was doctors who, paid piecemeal for the services they provide, load up patients with marginal tests and treatments. In fact, America’s health care system is not much different from other developed countries in the volume of service. Our doctors prescribe more or less the same number of pills and X-rays, perform similar numbers of blood tests and surgeries, as doctors in the best European countries.

. . . Another problem with P4P is that providers learn how to manipulate the results. “Once you define performance, people manage toward those metrics and neglect other things that don’t get counted,” said the Princeton health economist Uwe Reinhardt, who writes for The Times’s Economix blog. New York doctors have a favorite, possibly apocryphal, story of medical providers gaming the system: Miami hospitals that use patient feedback as a performance measure wait until spring to do their surveys, because that’s when the cranky, hard-to-please New Yorkers go home from their winter refuge.

Read the whole piece here. 

 

 

“Pay for Performance” May Not Work Quite as Well as Hoped for in Improving Healthcare Costs and Results, Explains Times’ Editor

 

see also:

• Why Concierge Medicine Will Get Bigger —CBS Marketwatch  [1/30]
• Texas Systems Latest to Launch ACOs —Modern Physician   [1/30]

 

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Write editor Dave Dix.