Favorite Quotes
"For every complex problem, there is a solution that is simple, neat, and wrong." - HL Mencken
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"I hear and I forget. I see and I remember. I do and I understand." - Confucius
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"The good physician treats the disease; the great physician treats the patient who has the disease" - Sir William Osler
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" The best test of a person's character is how he or she treats those with less power." - Bob Sutton
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"Those are my principles, and if you don't like them - well, I have others." - Groucho Marx
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"The difference between genius and stupidity is that genius has its limits." - Albert Einstein
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"It is hard enough to remember my opinions, without also remembering my reasons for them" - Friedrich Nietzsche
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"Anyone can make the simple complicated. Creativity is making the complicated simple." - Charles Mingus
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"Not everything that can be counted counts, and not everything that counts can be counted." - Albert Einstein
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"A foolish consistency is the hobgoblin of little minds, adored by little statesman and philosophers and divines. With consistency a great soul has simply nothing to do." - Ralph Waldo Emerson
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"This ain't no party, this ain't no disco, this ain't no fooling around." - Talking Heads, Life During Wartime
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"What is hateful to you, do not do to your neighbour. This is the whole Torah; all the rest is commentary. Go and learn it." - Hillel, Talmud, Shabbath 31a
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"You will never understand bureaucracies until you understand that for bureaucrats procedure is everything and outcomes are nothing." - Thomas Sowell
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"An idealist is one who, on noticing that a rose smells better than a cabbage, concludes that it will also make better soup." - HL Mencken
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"If you only have a hammer, you tend to see every problem as a nail." - Abraham Maslow
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"A great teacher is one who realizes that he himself is also a student and whose goal is not to dictate the answers, but to stimulate his students creativity enough so that they go out and find the answers themselves." - Herbie Hancock
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"There are no facts, only interpretations." - Nietzsche
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"An education isn't how much you have committed to memory, or even how much you know. It's being able to differentiate between what you do know and what you don't." - Anatole France
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"In character, in manner, in style, in all things, the supreme excellence is simplicity." - Henry Wadsworth Longfellow ====
Nov - 15
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AAFP endorses P4P
4 Oct2005
Pay-for-Performance Has Quality-Improvement Potential, AAFP Says
Despite the concerns that the medical community has expressed about the burgeoning pay-for-performance (P4P) movement — lack of standardized measures, the burden of data collection, and the “nonquality” factors driving the model — family physicians should prepare to participate in P4P programs for the noneconomic benefits their practices may accrue, according to Bruce Bagley, MD, the American Academy of Family Physicians (AAFP) medical director for quality improvement.
“The point is to encourage physicians to start collecting [performance] data prospectively —whether they’re using a paper-based checklist or a computerized method,” Dr. Bagley said, because performance measurement is clearly on the rise and family physicians in even nonurban U.S. regions are likely to see P4P programs emerge in the near future.
Speaking to attendees here at AAFP’s Scientific Assembly, Dr. Bagley and other presenters discussed the advantages and disadvantages of the P4P movement and discussed AAFP’s current and planned resources designed to help members prepare their practices for P4P participation. Dr. Bagley acknowledged that the biggest roadblock in P4P is the lack of standardized measurements, an issue that has emerged as a chief concern among physicians.
“That’s really the No. 1 issue — to get all of the entities [health plans, purchasers, and the government] offering P4P programs to adopt the same standardized measure sets,” he said, an effort that the AAFP, other physician organizations, and the National Quality Forum, among others, are pursuing. “Right now, for example, we’ve seen as many as eight to 10 diabetes [management] performance measurements — so what we have said is that we need standardized ambulatory measures, and we need them now.”
We must strive for standard transparent measures which physicians understand and endorse. P4P will not improve quality as much as the cheerleaders believe – but it may help us understand some features of quality.
I hope that good researchers carefully study these implementations. We must carefully study this system to understand its impact.
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Related posts:
- Safety rather than quality
- My position on performance measures
- Comparative effectiveness research – more thoughts
- Anonymous creates a strawman argument of P4P
- Can we measure quality?
Related posts brought to you by Yet Another Related Posts Plugin.
- In: General| Medical Rants
4 Responses to AAFP endorses P4P
Chris Rangel MD
October 5th, 2005 at 1:43 pm
“The point is to encourage physicians to start collecting [performance] data prospectively —whether they’re using a paper-based checklist or a computerized method,”
Could a P4P system improve care and outcomes? Maybe! What is it more likely to do? –> It’s much more likely to dramatically increase the paperwork/charting burden of physicians and to give insurance companies even more excuses to deny reimbursements, i.e. saying that not all of the necessary performance parameters were addressed and documented for a particular patient.
The other danger is that these “standards” of care risk encouraging “cookie cutter medical practice” instead of what physicians usually do which is tailoring the treatment to the patient. Not every patient with CHF should be on an ACE inhibitor. Not every patient with a history of MI should be on/or tolerate a beta-blocker. What happens when a poorly controlled diabetic absolutely refuses to start on insulin????
How will P4P affect my practice? Will I be penalized for non-compliant patients? Will I have to tell them to go elsewhere? What happens if a ground breaking study comes out that requires an overnight change in the standards of care? Will I continue to be under-reimbursed until the insurance company catches up with the new standards?
P4P in our current system is a really BAD idea. Treatment guidelines for practice are excellent but there are way too many factors not entirely under the control of the physician that influence outcomes to have reimbursements strictly tied to these. It’s a really, really bad idea.
Dr. Bob
October 5th, 2005 at 8:32 pm
It’s a good idea if it’s implemented well. It will probably be hijacked by the insurance companies to decrease payments though. Similar to how they morphed managed care into a tool for the short term management of their costs by denying care & throwing up obstacles to care.
We’ve been doing our own quality of care tracking for the last 18 months with our EMR (Practice Partner through the Practice Partner Research Network). I’m convinced this is helping us to provide better care by highlighting our shortcomings and where we need work. Quality of care tracking will be very helpful for us if we can then create lists of who is missing, e.g., which diabetics haven’t had a flu shot yet when December rolls around & sending out a reminder to come in & get one.
Our dentist, vet, & furnace repair man are good about sending out reminders when preventive maintenance are due, but us physicians are terrible about doing likewise. We need to do a better job of tracking what we’re missing. Medicine is getting so complex today that we need some form of tracking to assist us, there is just too much to keep in your head anymore.
Dan Smith MD
October 10th, 2005 at 1:24 pm
I share a lot of the stated misgivings on P4P. My office does not yet have an EHR…not enough $$ for the conversion. There are some extremely good features about it that will help us to bring better care to those who want it. And there’s the rub: P4P is going to further inflame the tendency to cherry pick out the compliant, mildly affected individuals whose quality indicators will lead to improved reimbursement. The non-compliant, ignorant diabetics will grow worse and be shuttled between care systems and doctors who will not want to treat them because they are a financial burden
Marshall Maglothin, MHA
October 27th, 2005 at 10:21 am
RE: “The non-compliant, ignorant diabetics will grow worse and be shuttled between care systems and doctors who will not want to treat them because they are a financial burden”
It seems that this is holding a patient responible for being a positive contributor to their own health & healthcare – and their physician for encouring and supporting this invovlement/compliance…is that a bad thing?