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QUALITY/POLICY: P4P get official in Businessweek, no less

So in a remarkable bit of futurism, only 8 years after Greg Schmid invented the concept at IFTF (well, we end up calling it performance-based reimbursement, but it’s the same thing as P4P), Businessweek has noticed and Pay for Performance has gone mainstream.

I’m still looking for someone to find an earlier citation of an equivalent term or concept–I still can’t believe that we allowed a non-healthcare economist to invent the term!  And with reference to the Gianfranco post from yesterday…. Greg came into work every day for 5 years and always said to me "How come they named the football team you support after the President’s daughter?"

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arabalarEric NovackRichard FerriDonald E. L. Johnsongadfly Recent comment authors
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arabalar
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I was very pleased to find this web-site.I wanted to thanks for your time for this wonderful read!! I definitely enjoying every little bit of it and I have you bookmarked to check out new stuff you blog post.

Eric Novack
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All of the major insurers will be rolling out “pay for peformance” systems with publicly available ratings and possibly even higher copays for those physicians who do not meet their criteria. Please watch– the word “efficient” or an equivalent will always be used– this is a not so thinly veiled reference to the fact that they will reward the “cheapest” physicians– i.e. those who utilize the least services. Complications occur– some are clearly preventable and perhaps compensation for these should be modified. But the implication above that complications some how are viewed by doctors as a way to line their… Read more »

Richard Ferri
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Richard Ferri

I have to weight in on the nursing shortage. I have been an RN/Nurse Practitioner for 30 years. It has to be said LOUDLY that nursing is a great profession men and women. While nurses always come up as one the most trusted professions in the poll we continue to suffer from lack of media support. I was furious that when Nurse Abby on the TV show ER wanted to further her education she went to medical school to become and MD rather than to graduate school to be an NP. This media message (and there are numerous other examples)… Read more »

Donald E. L. Johnson
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Matthew,
I’ve been writing about pay for non performance in health care for almost 30 years. When patients get nosocomial infections because doctors don’t wash their hands and when patients are misdiagnosed, both hospitals and docs are paid to try to fix the problems they created. Only in American health care.

Abby
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Ron,
Some people get depressed and hallucinate. Those people need help. And some people can’t function properly w/o meds. (I’m sure that you’re not a scientologist, but I want to point out that those people think that all of psychiatry is basically a fascist plot.)
I can imagine that there are crooked doctors.
I’m not sure how that affects P4P. The question is less about the inputs and more about the quality of the output. If you can get a better result doing it a different way, why shouldn’t you?

Ron Greiner
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Ron Greiner

Abby, You ask, //Please elaborate on the “noncovered expense” portion of your reply. It seems to me that employers might push insurers to rewrite the contracts. So what’s standard now could change.// Many times people have procedures done one way that is a covered expense on their insurance when there is an alternative procedure that would be a noncovered expense. It has been reported that some doctors will do a procedure that is a noncovered expense but then bill the procedure as a covered expense (a different procedure code) to get paid. I do believe some people get sad or… Read more »

gadfly
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gadfly

There is already pay for performance in terms of paying Doctors for meeting “quality criteria”. The problem is that the health care providers are setting the criteria and determining how it gets measured. (Or they own the “outside organization” that measures Quality, like NCQA). What that means is that physician performance skews toward this criteria. They have more motivation to diagnose and follow “mainstreamed” diseases like diabetes, asthma, or cardiac problems than to screen for or work with “orphan diseases”. In simple terms, provider-controlled quality standards encourage doctors to “teach to the test”. Giving bonuses for this is a sign… Read more »

Abby
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Ron,
As much as I wish that there were blood tests for serious mental illness, there aren’t yet, but these diseases are real.
Are you saying that major depression is not a real disease? (I am agnostic on the question of whether ADHD is overdiagnosed and too many kids are on ritalin.)
Please elaborate on the “noncovered expense” portion of your reply. It seems to me that employers might push insurers to rewrite the contracts. So what’s standard now could change.

Ron Greiner
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Ron Greiner

The problem with insurance paying bonuses because of outcomes is pretty simple, it would be a noncovered expense. Insurance will pay 5 times more for a covered procedure and will not pay 80% less for a noncovered expense. We see it all the time. The general population can’t tell the difference between schizophrenia and depression. Today when a woman is dumped by her husband, some docs put her on medication. Doctors put kids on Ritlin and say there is a chemical imbalance and they never ran a test to prove their gut feelings. These Docs are like Mr. Spock with… Read more »

Abby
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Ron, I don’t think that pay for performance requires single-payer. Matthew, I saw that article. Has anyone tried that with mental health? I’m thinking of the really catastrophically serious illnesses like schizophrenia. Of course, most of those people are in some sort of public system. I read that Tenn Care is trying to discourage the use of Zyprexa. This sounds penny wise, pound foolish. If there were some sort of performance aspect, possibly tied to being able to hold down a regular job of some sort, then some of these short-term cost cutting solutions which are actually harmful to patients… Read more »

Ron Greiner
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Ron Greiner

I don’t think we are going to give doctors and hospitals bonuses for anything. Senator Grassley can play with government programs like Medicare because we should try anything with that program and all of it’s problems and fraud. You are calling soccer the wrong name. Football is a completely different sport in the US. There are some Tampa people who are going to correct that problem and start calling soccer it’s real name. You have probably heard of them. “Tampa Bay Buccaneers owner Malcolm Glazer informed Manchester United’s remaining shareholders Tuesday that he controlled 98 percent of the shares and… Read more »