How P4P can be dangerous if implemented poorly:
The hubris,arrogance and naivete that I believe characterize those who make rules for how to treat individuals based solely on group data ignoring the input of the physicians on the scene is even worse that the folks who simplistically sprout out coarse grain outcome data quality indicators such as percentages of patients with HbA1c less than 7 %. In the later they are just counting beans in the former they are making rules about treatment decisions that might be determinative of the outcome. It all seems to be part of the notion that medicine is too important to be left to the individual physicians and patients.
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- How following hospital quality measures can kill patients
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- "Poor-quality medicine is being rewarded; high-quality medicine is being punished"
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What they want to do is industrialize the process of providing medical care–applying basic industrial engineering. The best that can happen if they succeed is more care of a basic minimum quality for more people. That is what industrialization did for production of commodities, like, say furniture. More basic decent funiture for more people–but they are cheap and inferior trash in comparison the productions of craftsmen from prior ages.
What all these people are saying is that we can not afford medical care that allows the physician to do his best work as a craftsman, and gives patients individualized treatment taylored solely to them. They the most humanistic process must be dehumanized, reducing the pårticipants to ciphers.
It is possible to apply the basic principles of industrial engineering to health care… BUT EXTREME CAUTION MUST BE TAKEN.
A notion exists in the management literature of mass customization. The process must be standardized and there is not reason the way an appointment is taken, or a sign-in is done or a blood test is drawn should differ from visit to visit. Yet the experience from the other side of the service line should always be unique.
This is the craft, this is the art.
But the devil is in the details and, in this case, in the execution of a good plan…
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