Another problem with P4P


Category : Medical Rants

Kudos to KevinMD for noting this article. I have wondered about the externalities associated with P4P. Wachter explicitly worried about physicians “playing to the test”. This study suggests that P4P does indeed lead to unintended (and undesirable) consequences. Performance Measures May Lead to Overuse of Antibiotics

Elderly patients hospitalized for suspected pneumonia may be getting antibiotics before their doctor is certain about the diagnosis, a new study suggests.

Among health-care professionals, the practice is known as “shoot first and ask questions later.” And the premature use of antibiotics for elderly patients with suspected pneumonia is often done to meet federal performance standards that dictate giving the drugs within four hours of arrival at a hospital.

“Some patients are probably getting antibiotics inappropriately in an attempt to deliver antibiotics quickly to meet externally mandated standards,” said lead study author Dr. Mark L. Metersky, a professor of medicine at the University of Connecticut School of Medicine.

The result can lead to increases in antibiotic resistance, unwanted side effects from the drugs, and difficulty identifying the underlying medical problem, the researchers said.

The findings are published in the July issue of the journal Chest.

So to restate the problem, CMS pays hospitals for providing antibiotics promptly (less than 4 hours) to patients with pneumonia. Thus hospitals encourage physicians to start antibiotics promptly, without proof that the patient indeed has pneumonia.

This is a classic sensitivity specificity problem. The only way to increase sensitivity is to sacrifice specificity.

Giving antibiotics to patients who do not really need them is a real problem, especially when you are dealing with elderly patients and using pneumonia strength antibiotics. Just another example of the law of unintended consequences (or undesirable externalities).

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