Comments on: Does paying for quality actually work? http://www.kevinmd.com/blog/2008/11/does-paying-for-quality-actually-work.html medical blog Sun, 22 Nov 2009 22:50:49 -0500 http://wordpress.org/?v=2.8.4 hourly 1 By: Anonymous http://www.kevinmd.com/blog/2008/11/does-paying-for-quality-actually-work.html/comment-page-1#comment-88248 Anonymous Thu, 20 Nov 2008 00:47:00 +0000 http://clients.emmense.com/kevinmd/2008/11/does-paying-for-quality-actually-work.html#comment-88248 Little discussed but also important are the P4P metrics that are patently unrelated to patient health yet quite prevalent -- the one that comes to mind is the brand-to-generic ratio. Usually listed under the "efficiency" elements of P4P, but included in the overall algorithm that ultimately determines monetary benefit. Patients should be informed, then outraged, by such an incentive system is clearly fraught with conflict of interest.<br/><br/>Tom from Boston Little discussed but also important are the P4P metrics that are patently unrelated to patient health yet quite prevalent — the one that comes to mind is the brand-to-generic ratio. Usually listed under the “efficiency” elements of P4P, but included in the overall algorithm that ultimately determines monetary benefit. Patients should be informed, then outraged, by such an incentive system is clearly fraught with conflict of interest.

Tom from Boston

]]> By: David Harlow http://www.kevinmd.com/blog/2008/11/does-paying-for-quality-actually-work.html/comment-page-1#comment-88236 David Harlow Wed, 19 Nov 2008 05:03:00 +0000 http://clients.emmense.com/kevinmd/2008/11/does-paying-for-quality-actually-work.html#comment-88236 Kevin, Jason -- <br/><br/>Consider the Premier HQID Demo as a counterexample. <br/><br/>"[I]f all hospitals nationally were to achieve the three-year cost and mortality improvements found among the HQID project participants for pneumonia, heart bypass, heart failure, heart attack (acute myocardial infarction), and hip and knee replacement patient populations, they could save an estimated 70,000 lives per year and reduce hospital costs by more than $4.5 billion annually."<br/><br/>-- from Premier press release. <br/><br/>See my post on this with links to Premier (and other posts, of course) at:<br/><br/>http://healthblawg.typepad.com/healthblawg/2008/02/premier-hqid-de.html <br/><br/>I have a different problem with P4P: By necessity, a P4P project focuses on a handful of indicators, and then directs $$ to top performers. Thus, other significant indicators are possibly given short shrift by providers, and the providers who don't do as well on the indicators of interest get paid less and may devolve into a death spiral of sorts.<br/><br/>Bottom line, some P4P programs really do work, but if you look beyond the boundaries of the program, you will likely see some unintended consequences. Kevin, Jason —

Consider the Premier HQID Demo as a counterexample.

“[I]f all hospitals nationally were to achieve the three-year cost and mortality improvements found among the HQID project participants for pneumonia, heart bypass, heart failure, heart attack (acute myocardial infarction), and hip and knee replacement patient populations, they could save an estimated 70,000 lives per year and reduce hospital costs by more than $4.5 billion annually.”

– from Premier press release.

See my post on this with links to Premier (and other posts, of course) at:

http://healthblawg.typepad.com/healthblawg/2008/02/premier-hqid-de.html

I have a different problem with P4P: By necessity, a P4P project focuses on a handful of indicators, and then directs $$ to top performers. Thus, other significant indicators are possibly given short shrift by providers, and the providers who don’t do as well on the indicators of interest get paid less and may devolve into a death spiral of sorts.

Bottom line, some P4P programs really do work, but if you look beyond the boundaries of the program, you will likely see some unintended consequences.

]]> By: Anonymous http://www.kevinmd.com/blog/2008/11/does-paying-for-quality-actually-work.html/comment-page-1#comment-88231 Anonymous Wed, 19 Nov 2008 02:11:00 +0000 http://clients.emmense.com/kevinmd/2008/11/does-paying-for-quality-actually-work.html#comment-88231 P4P, as described above, will not work because there are too many layers separating money from the patient. In a more direct transaction, input is quite rapid: "You did a poor job, you won't see a dime more of my money", or, "You did a great job, I'll mention your name to those I like."<br/><br/>And yes; very important question. When chosing what to measure, do they chose those things that count as performance in the eyes of the patient or the insurer? P4P, as described above, will not work because there are too many layers separating money from the patient. In a more direct transaction, input is quite rapid: “You did a poor job, you won’t see a dime more of my money”, or, “You did a great job, I’ll mention your name to those I like.”

And yes; very important question. When chosing what to measure, do they chose those things that count as performance in the eyes of the patient or the insurer?

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