Comments on: Pay for performance unintended consequences http://www.kevinmd.com/blog/2008/10/pay-for-performance-unintended.html Tue, 14 Feb 2012 23:00:00 +0000 hourly 1 By: Anonymoushttp://www.kevinmd.com/blog/2008/10/pay-for-performance-unintended.html#comment-87840 Anonymous Thu, 30 Oct 2008 00:04:00 +0000 http://clients.emmense.com/kevinmd/2008/10/pay-for-performance-unintended-consequences.html#comment-87840 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. 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.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2008/10/pay-for-performance-unintended.html#comment-87817 Anonymous Tue, 28 Oct 2008 17:58:00 +0000 http://clients.emmense.com/kevinmd/2008/10/pay-for-performance-unintended-consequences.html#comment-87817 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.<br/><br/>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. 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.

]]> By: Bianca Castafiorehttp://www.kevinmd.com/blog/2008/10/pay-for-performance-unintended.html#comment-87801 Bianca Castafiore Mon, 27 Oct 2008 23:58:00 +0000 http://clients.emmense.com/kevinmd/2008/10/pay-for-performance-unintended-consequences.html#comment-87801 "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."<br/><br/>And MALE? “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?

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