Comments on: AAFP endorses P4P

By: Marshall Maglothin, MHA

Marshall Maglothin, MHA — Thu, 27 Oct 2005 16:21:23 +0000

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?

By: Dan Smith MD

Dan Smith MD — Mon, 10 Oct 2005 19:24:33 +0000

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

By: Dr. Bob

Dr. Bob — Thu, 06 Oct 2005 02:32:43 +0000

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.

By: Chris Rangel MD

Chris Rangel MD — Wed, 05 Oct 2005 19:43:58 +0000

“The point is to encourage physicians to start collecting [performance] data prospectively â€”whether theyâ€™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.