Anonymous creates a strawman argument of P4P

13 Oct
2009

An anonymous commenter writes:

While I agree that P4P is not likely to be effective at motivating individual physicians to do all tasks, it may motivate larger group physician practices to create decision support or other interventions to enable physicians to perform better by making it the right thing to do the easiest thing to do. Creation of such interventions requires money, which P4P would provide. Whether the improved quality of care and subsequent improvement in health would outweigh the incentive to cut under-served populations from your patient census is debatable. To be ultimately successful P4P must incorporate additional regulations that disincentivize negative behaviors.

I fear that anonymous misses the point. P4P will likely only address a minority of the activities of the physician or the group. If we focus on these activities, we must take energy away from other activities. P4P tells us explicitly that these are our most important tasks. Yet, I continue to argue that these tasks are chosen because they can be chosen. We can measure these things, so we do.

Measuring diagnostic errors is much more difficult, and yet I would argue much more important. Crafting a treatment regimen around the patient’s many diseases and economic situation is much more difficult and more important. Teaching the patient about their disease and their treatment trumps many performance measures.

The problem with P4P is that it perverts the physician role.

I favor measuring many performance indicators within one’s practice. We should examine those things that we can and strive to improve, if improvement is feasible. The danger of performance indicators occurs when others – insurance companies, report card writers or the government – use performance scores as a proxy for quality. We see performance indicators used irrationally every day, so we must make the argument against P4P and performance reporting as being destructive to patient care, and thus patients.

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1 Response to Anonymous creates a strawman argument of P4P

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Doc99

October 13th, 2009 at 5:39 pm

Where’s the evidence that P4P improves outcomes?

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