Think about it. If consumers/patients increasingly shoulder the decision-making process about what part of the healthcare dollar to spend on which intervention, test, or visit, and are increasingly responsible for educating themselves and pursuing prevention and treatment, then physicians’ control over what patients do or don’t do will shrink (no pun intended).

Which means that the “performance” will be under the consumers’ control, not ours. If we are paid for performance, then the rewarded behavior will be to have patients who follow like sheep, and to get rid of ones who don’t do as they are told.

This doesn’t sound like progress. What does sound like progress is to apply P4P to the CONSUMER. Pay them for good hgb A1C’s, for good cholesterol levels, for taking their atenolol.

Now, that makes sense. Docs then become their consultants/advisors, helping them make the right decisions. If patients are to be fully placed in the driver’s seat, then pay them to do a good job.

(Yes, good health is a reward in itself, but the pay off is so far down the road, folks need some immediate gratification to maximize healthy behaviors.)