http://www.medrants.com/archives/5093 Internal medicine, American health care, and especially medical education Sat, 11 Feb 2012 15:15:48 +0000 hourly 1 http://wordpress.org/?v=3.3.1 http://www.medrants.com/archives/5093/comment-page-1#comment-530766 pcb Mon, 14 Dec 2009 01:45:22 +0000 http://www.medrants.com/?p=5093#comment-530766 Polypharmacy is one of the huge negative consequences of P4P schemes.  I know some excellent physicians who feel one of their main purposes in medicine is to pare down the med lists of patients they care for.  Do bad there's not a quality measure for prioritizing a patient's med list to best suit the needs of the patient rather than their individual diseases.  Polypharmacy is one of the huge negative consequences of P4P schemes.  I know some excellent physicians who feel one of their main purposes in medicine is to pare down the med lists of patients they care for. 
Do bad there's not a quality measure for prioritizing a patient's med list to best suit the needs of the patient rather than their individual diseases. 

]]> http://www.medrants.com/archives/5093/comment-page-1#comment-530763 solo dr Sat, 12 Dec 2009 23:57:02 +0000 http://www.medrants.com/?p=5093#comment-530763 P4P is similar to some of the capitated Medicare HMOS in my area. I elected not to join the HMOs, as each group or physician is paid based on efficiency and quality. Bonuses can reach 6 digits at the end of the year, as long as you do not have sick patients. Monthly payments based on efficiency and number of patients are paid to each physician. Office visits are discouraged, as grater than 3 visits/patient means the doctor loses money. Inpatient care is not covered by capitation, so inpatient stays are extremely short. What happens is the groups with the sickest patients "depanel" them to the new docs, so that the groups can maintain their bonuses. P4P is similar to some of the capitated Medicare HMOS in my area. I elected not to join the HMOs, as each group or physician is paid based on efficiency and quality. Bonuses can reach 6 digits at the end of the year, as long as you do not have sick patients. Monthly payments based on efficiency and number of patients are paid to each physician. Office visits are discouraged, as grater than 3 visits/patient means the doctor loses money. Inpatient care is not covered by capitation, so inpatient stays are extremely short. What happens is the groups with the sickest patients "depanel" them to the new docs, so that the groups can maintain their bonuses.

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