Is the P4P concept fatally flawed? It doesn’t seem like it matters, as it’s moving forwards anyways:
n the United Kingdom, for instance, researchers found that the national P4P program introduced in 2004 motivated general practitioners to improve care by making better use of previously underused information technology and multidisciplinary teams. Bruce Guthrie, MB BChir, PhD, of the University of Dundee, in Dundee, Scotland, who presented a study on the U.K. program, said general practitioners worried about two negative consequences of P4P:Tunnel vision: Concentrating on the conditions eligible for incentives means less time for patients with conditions that were not being measured by the program, such as depression.
Crowding out: Reducing or eliminating primary care services without specific reimbursement, such as travel medicine.
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My sense of P4P is that it has less to do with paying extra money for “good” performance than it has to paying less for what it deems “bad” performance. In other words, there is not going to be extra money set aside for P4P, it will just come out of what’s paid to others.
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