How is it any different or better than applying some index to a clinical activity in the manner of a “result” which can be scored and then used to index a payment for services (or a “bonus” to be first withheld, then bestowed, depending on “performance”)?

Unless there is a way to qualify the result to the initial clinical problem, the system will favor those practitioners who fix simple problems and disfavor those who must deal with difficult problems. Doctors with a patient population skewed to poor, obese, diabetics with poor glycemic control and significant comorbidities will have theirr work cut out for them if their metric is compared to others with a better–less complicated and comorbid– balance of patient problems.

A stick painted orange is not a carrot.

Note that the second article you discuss above was written by Dr John W Rowe, the immediate past-CEO, major stock-holder, and current board chairman of Aetna Inc. Clearly, it may be in the interest of Aetna Inc., a large commercial managed care organization, to promote P4P.
It is too bad that the Annals did not make Dr Rowe’s links to Aetna explicit in his article, which seems to amount to an exposition of Aetna’s position on the issue.
Another question is why the Annals gave Dr Rowe the opportunity to argue his company’s case without providing for an opposing point of view.
See this post:
http://hcrenewal.blogspot.com/2006/11/lecture-about-pay-for-performance.html/
in Health Care Renewal,
http://hcrenewal.blogspot.com/

data mining:

“Medicare investigators in Los Angeles, using sophisticated computer technology to sift through claims data, saw an unusual pattern: A single patient had apparently undergone a diagnostic rectal-probe procedure 118 times in a year — at 21 medical facilities….”
(read on: http://tinyurl.com/yb5xzd)

The 80s are over folks! Back then it seems that providers were very happy with how the second P was defined, by those other mean folks. (Whats the matter, trouble in paradisimo?)

No sympathy from this corner. Looks like the free market strikes back (second P redefined).

Whatever the guise, P4P can help prevent fraud, and thats important (for our children)! Now, just got to figure out a way to free the first P…

(but wait, why do i have to even think about freeing the first P. In an open market, denouced feudal society, in the 21st c, wth genomics, with healthIT… shouldnt this already be taken care of?)

the undoing?:
http://www.guardian.co.uk/medicine/story/0,,1945029,00.html
If he can do it, can i, can i… ?
(insert uninsured, underinsured, dispossessed, disenfranchised in queue OR just insert normal people wanting to make a buck and are ready to fill a gaping market need)

PS:
diy diagnostic health test sales are up.
I wonder if i can bill for that? (oops, forgot u have to be part of the oligarchy to do that…)

hmmm, maybe thats part of the problem with health delivery. But i wouldnt know, I didnt pay 100K+ to be allowed to get certified to bill.

oh another idea:
open up the certification process. lets say we let the free market find some people who would study real hard, pass the same or more rigorous state-certified test, and work happily for +/-80K…

I wonder how many people she (the market) could lure- that could pass the state test. If she found enough the work schedules and patient loads would be much smaller, these people could even use google or other resources. I wonder how many providers would have to rise to the incentives of the market that would bring about a mean doc salary of 80K (minus the whining about P4P pay schedules)?

wow, those sure are weird questions- maybe ill find the answer some day
(shame on us for not already have. its called freedom- of the markets, of information, of people. its a beautiful thing, and we enjoy it in a variety of forms everyday)

enjoy more!

please… please….
somebody save the children, somebody save my baby, please…
please, i surrender my rights, my dignity, we’ll allow a feudal priest class to diagnose and prescribe…

Hospital errors are in the top 10 ways to meet the reaper… so much for indentured servitude, cartel enforced residency training program!

please save the children.
(insert bagpipers)

new study: “About 20% of all diseases are misdiagnosed, a percentage that has remained steady since the 1930s. However, scientists have discovered that by inputting the key symptoms into Google they can get the correct diagnosis about 58% of the time. For rare and unusual diseases, this provides doctors the information they need to get a correct cure. Of course, Google is only as good as its knowledge base, and its users, so this isn’t a cure for everything.”
(but were getting there… of course w/o the help of those who argue nuances of P4P vs HMO vs blah blah vs BS… again, its simple artificial scarcity. Artificial scarcity of who is allowed to sell information (medical) wrapped in a save the children for ur rights argument.”
http://science.slashdot.org/article.pl?sid=06/11/11/0915230&threshold=-1

(as always)
ur options/rights:

go overseas: retain your dignity, do not become a charity case (the cartel loves to

market how charitable they are when it comes to rent collection)
http://www.planethospital.com/
http://www.iso.org/iso/en/ISOOnline.frontpage
http://www.fortishealthcare.com/
http://www.indushealthplus.com/

negotiate:
http://www.mymedicalcontrol.com/

NP:
walmart is rolling out $40 visits, i heard costco is thinking about this also(?)

credentialing (free-market style):
http://www.ratemd.com

search engines:
google health

-be careful out there

definitely internet access helps, I use some excellent on line sources @ 5 times/day. the medical library I use has extensive information on virtually every known disease. The only problem I have is the time issue….an google internet search can take quite a long time to sort through the hits, while a more organized medical database saves time. Any physician who does not have computer or electronic databases is either brilaint or out of date.

also I would note that being a priest is not even comparable to being a physician. The priest takes vows of poverty and chastity …the physician takes no such vows.

Dr Abhishek Mishra is an experienced orthopaedic surgeon in Delhi for joint replacement surgeries such as hip and knee replacement and arthroscopy surgery as well. You can meet Dr Abhishek Mishra at VNA hospital, Malviya Nagar, Delhi. https://www.vnahospital.com/orthopedics-treatments/knee-replacement/