Pay for Performance devised to overtake the Fee for service payment model-

                                                Is the system ready?

There has been much talk about pay for performance as the next step in improving healthcare delivery and cutting down on costs.  Rather than reimbursement for services rendered, as is the current model, in pay for performance doctors and other healthcare providers are paid for reaching set criteria for healthcare quality.

While there have been more than 100 private and governmental pilot programs  trying this in  large healthcare systems, they have met with only slight improvement to efficacy and outcomes.  There has actually been no savings due to increased administrative costs. There has been concern voiced regarding the criteria, information security and patient-physician autonomy as well as the added burden to an already burdened administration.

A very real threat to healthcare when reimbursement and outcome improvement is linked is:

  • Doctors may refuse to care for high-risk patients
  • Weeding out of patients with low health knowledge or capability to select and carry out healthcare options
  • Ignoring the poor who can’t afford costly drugs and treatments


AMA Guidelines for Pay-for-Performance programs

Published principles include:

  • Accuracy of health data
  • Positive incentives
  • Voluntary participation by physicians, health facilities and hospitals
  • Encouraging patient-doctor relationships
  • Accountability shown with public scorecards

Objections and views of various professional associations

  • American Academy of Family Physicians: “there are a multitude of organizational, technical, legal and ethical challenges to designing and implementing pay for performance programs”
  • American College of Physicians: “adoption of appropriate quality improvement strategies, if done right, will result in higher quality patient care leading to increased physician and patient satisfaction. But the College is also concerned that these changes could lead to more paperwork, more expense, and less revenue; detract from the time that internists spend with patients, and have unintended adverse consequences for sicker and non-compliant patients…. concerned about using a limited set of clinical practice parameters to assess quality, especially if payment for good performance is grafted onto the current payment system, which does not reward robust comprehensive care.”
  • American Geriatrics Society: “quality measures (must) target not only care for specific diseases, but also care that addresses multiple, concurrent illnesses and (are) tested among vulnerable older adults. Using indicators that have been developed for a commercially insured population…may not be relevant”
  • American Academy of Neurology (AAN): “An unintended consequence is that current relative payments are distorted and represent a misaligned incentive system, encouraging diagnostic tests over thoughtful and skilled patient care. The AAN recommends addressing these underlying inequities before a P4P program is adopted.
  • The Endocrine Society: “it is difficult to develop standardized measure across medical specialties…variations must be allowed to meet the unique needs of the individual patient…P4P programs should not place financial or administrative burdens on practices that care for underserved patient populations”

At a time when the public is trying to understand ACA requirements and obtain coverage through various healthcare exchanges, a further change to the healthcare system may be too confusing altogether at this time.

What are your thoughts on the issue?  Share your views in the comment box below.