By the way it’s currently designed and implemented, it certainly seems that way.
Medicare seems intent on burying the P4P concept. Bob Doherty notes that “successful quality improvement programs provide regular feedback to clinicians on how they are doing. Rewards for reporting should be greater than the costs and hassles of reporting. The rewards should be predictable (if I do x, I will receive y). And the timing of providing the rewards should be closely linked to when the reporting took place.”
None of this is true with Medicare’s piss-poor attempt at linking payments to quality measures.
Related posts:
- Medicare pay for performance, what went wrong?
- Medicare’s dismal pay for performance
- Pay for performance unintended consequences
- Prescription medication pay for performance, and the rationale behind it
- Does the AMA secretly want to kill primary care?
- Extreme pay for performance
- Does pay-for-performance work, and will it improve health care quality or patient outcomes?
KevinMD.com on Facebook
{ 4 comments }
Medicare has no intent. It is not an entity that possesses a unitary mind of any sort and is therefore incapable of the state of intent. This is not just linguistic nitpicking but is materially important in understanding healthcare bureaucracy and in managing it’s impact on you. I work in the bureaucracy and find the end actions to be unrelated to any intent or scheme by higher management. Rather they are the net result of myriad disconnected unplanned processes the full interrelationships of which has never been studied, mapped or characterized in any way–they have just evolved. Competing subsystems clash with other susbsystems in ways that produce end actions that no one plans or intends.
It should want P4P to fail. It’s time for pay for outcomes
Anon 6:53 nailed it. I hope you’re all paying attention. For a fuller explanation of this key political understanding, see Graham Allison’s classic paper on the Cuban Missle Crisis.
Wikipedia gives a decent summary:
http://en.wikipedia.org/wiki/Essence_of_Decision
It’s having this nuanced perspective that separates the policy professionals from the policy amateurs. Here’s to the professionals!
Few physician have any education in organizational psychology and sociology. Yet, given that we are no longer working autonomously, a lack of this knowledge leaves us helpless to defend our essential professionalism from those forces destroying it. Most often in our ignorance, we assist the forces of dissolution.
Comments on this entry are closed.