QUALITY: Millenson on Pay For Perfomance

Michael Millenson week continues here at THCB!

Despite giving my team at IFTF almost no credit for inventing the phrase (oh, I can be as petty as any academic!) Michael has written a pretty good article called Pay for Performance: The best worst choice. Millenson notes that some adherents of antecedents of P4P existed long ago in the medical system before the AMA had them taken out, put up against the wall and shot (or the professional equivalent). Given that Millenson quotes the AMA Chair as saying that P4P is a "scam designed by multi-millionaire Health Plan CEOs to take advantage of gullible physicians", it seems that some things have changed little. And why would you want your performance be reflected in your pay, especially as your performance is apparently as bad (or at least as inconsistent) as much of the care delivered in this country, even by the most prestigious institutions. (See 30 years worth of Wennberg et al if you don’t believe me). For that matter, given the ability of the plans and the rest of the suppliers to game the system in the past, I would be worried as a doctor is I was going to essentially give a with-hold away that I might not see back. But for the rest of us, as Millenson says, given the choice that we have now, P4P is the best one out there.

BTW the article is published in a somewhat obscure British journal called Quality and Safety in Health Care. It’s subscription only, but you dear reader can get to this article by special arrangement only from this page. Ooh, the power of THCB!

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