The P4P debate


Category : Medical Rants

Readers know how I would vote on this debate.  Should Physician Pay Be Tied to Performance?

The con side is well done, however, it does miss a major point.  Performance is too complex to summarize in measures.  We have a responsibility to individualize therapy – be patient centric. Some patients deserve different goals than others.  Trying to assume that we should always treat each disease in the same way ignores the co-morbidities, the social situation, the patient’s age and many other issues.  Performance measurement does not apply to every patient, because we will never have performance measures for every disease and every manifestation of the disease.  Performance measurement does not value diagnosis.  It does not value bedside manner – patient satisfaction is NOT a proxy for bedside manner.

P4P is a horrible idea for many reasons.  But the wonks will not give up this idea.

Comments (6)

How about pay for performance for policy wonks? Administrators? Etcetc etc …

All too often, performance is conflated with conformance.

Insightful perspective. This is something that I had not previously considered. The questions remains: 1. How to we improve quality of care; 2. How do we pay physicians? If P4P isn’t the answer…

You ask a 10 million dollar question. Quality of care will improve when the mass of health care providers provide thoughtful care (not reflexive… Not every nursing home demented patient who falls need a surgery and plenty of consults to achieve it; not every shortness of breath is copd or chf or pneumonia or PE; not every LDL more than 130 require medicines). In our current society and system, I do not think it is possible; minority of people like readers and writers on this blog will keep yearning for it… just my view.

The focus of P4P is very narrow; sure, you can fix some things it but it does not get rid of major issues in our system. Doctors are smart people and can easily play around the rules. If we hypothesize this as a game, very few people can play it better than the players themselves.

I can’t count the number of 90 year olds that get admitted to Hospital on 15 plus meds. Can someone show me the data that statins help 90 year olds live longer and better?

spot on – common sense is no longer valued – clinical judgment is no longer valued – your are so correct

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