Comments on: Pay for performance follies http://www.kevinmd.com/blog/2008/09/pay-for-performance-follies.html Tue, 14 Feb 2012 17:18:00 +0000 hourly 1 By: Anonymoushttp://www.kevinmd.com/blog/2008/09/pay-for-performance-follies.html#comment-87265 Anonymous Wed, 10 Sep 2008 13:01:00 +0000 http://clients.emmense.com/kevinmd/2008/09/pay-for-performance-follies.html#comment-87265 Interesting article...but where's the "but-for" evidence that the 6-hour antibiotic rule led to this patient's C. diff? That's right; there's none. In fact there's never been a study showing adverse patient outcomes due to the antibiotic timing rule, even at 4 hours. The best anybody's been able to come up with are 2 single-institution studies suggesting diagnostic inaccuracy. But in the context of a national reporting program, single institution studies are just anecdotes. Institution-level decisions (and plain old random variation, since dozens of unpublished institutions probably looked into similar data) dominate institution-level results.<br/><br/>Of course, in the NYT, you don't even need an institution...a single patient will suffice. I once had this patient whose gout stopped bothering her after the Sox won the world series. Clearly baseball works!<br/><br/>Evidence (or lack thereof) may not change minds here, but isn't it worth thinking scientifically about P4P? Why not treat P4P like any other medical intervention and wait for the results to come in before pre-judging it? Interesting article…but where’s the “but-for” evidence that the 6-hour antibiotic rule led to this patient’s C. diff? That’s right; there’s none. In fact there’s never been a study showing adverse patient outcomes due to the antibiotic timing rule, even at 4 hours. The best anybody’s been able to come up with are 2 single-institution studies suggesting diagnostic inaccuracy. But in the context of a national reporting program, single institution studies are just anecdotes. Institution-level decisions (and plain old random variation, since dozens of unpublished institutions probably looked into similar data) dominate institution-level results.

Of course, in the NYT, you don’t even need an institution…a single patient will suffice. I once had this patient whose gout stopped bothering her after the Sox won the world series. Clearly baseball works!

Evidence (or lack thereof) may not change minds here, but isn’t it worth thinking scientifically about P4P? Why not treat P4P like any other medical intervention and wait for the results to come in before pre-judging it?

]]> By: PharmacistMikehttp://www.kevinmd.com/blog/2008/09/pay-for-performance-follies.html#comment-87257 PharmacistMike Tue, 09 Sep 2008 16:25:00 +0000 http://clients.emmense.com/kevinmd/2008/09/pay-for-performance-follies.html#comment-87257 I can't remember if it was Pennsylvania or New York that started the quality rating for cardiac surgery. In that same time period there was a large increase in referrals from that state to the Cleveland Clinic for cardiac surgery cases. Bottom line is that it doesn't look good to operate on the sickest patients so transfer them to a regional center. That is just great for the patient and their family. I can’t remember if it was Pennsylvania or New York that started the quality rating for cardiac surgery. In that same time period there was a large increase in referrals from that state to the Cleveland Clinic for cardiac surgery cases. Bottom line is that it doesn’t look good to operate on the sickest patients so transfer them to a regional center. That is just great for the patient and their family.

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