Health policy wonks need to read medical blogs. Unexpected results from simplistic pay for performance measures were predicted early on by several medical bloggers.
Consider the fact that hospitals will have little incentive to treat certain populations under Medicare’s pay for performance system:
That means that hospitals serving large groups of the elderly, women, poor, uninsured, or African-American patients might have problems competing with institutions whose patients are younger, wealthy, insured, and white.
And you wonder why more hospitals are moving to the suburbs.
Related posts:
- Unintended consequences of EMTALA
- Unintended consequences of mandates
- The unintended consequences of P4P
- The unintended consequences of electronic records
- The unintended consequences of free HIV screening at hospitals
- The unintended consequences of preventing patient falls
- USA Today op-ed: Medicare’s never events and the unintended consequences affecting patient care
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“That means that hospitals serving large groups of the elderly, women, poor, uninsured, or African-American patients might have problems competing with institutions whose patients are younger, wealthy, insured, and white.”
And MALE?
Not to nitpick, but the study showed a pretty small unintended _incentive_ for hospitals. Not an unintended _consequence_ for patients. It’s the latter that matters.
I think it would be nice to show a little humility…what hospitals will actually do in response to CMS’s P4P pilot is pure speculation. The magnitude of the financial incentive created by low Medicaid payments and losses to uninsured payments far exceeds any proposed P4P incentive.
Pay for performance is an attempt to beaurocratically replace what freedom naturally fostered when people used their own money to buy medical care at freely agreed upon prices from the doctor and hospital that they and their neighbors had good experiences with—and it can not do so effectively and will fail. The patient never had the data that the government can get–but the data is usually garbage anyway and subjective judgment can much better integrate the large volume of data of uncertain value, and idiosyncratic personal choices that make for quality medical care.
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