Does pay-for-performance work, and will it improve health care quality or patient outcomes?

Currently, most physicians are paid by the number of patients they see, or the amount of procedures they do.

Pay-for-performance, a payment system where doctors are paid based on meeting patient outcome measures, is how most insurers, along with Medicare, would like to see the payment system be reformed.

But does it really improve health care quality?

Pauline Chen looks at the data, and finds precious little definitive conclusions. “I found it nearly impossible to find the kind of randomized control study I have come to trust when evaluating experimental drugs or even new devices or surgical therapy,” Dr Chen writes. “And the few studies that have been published are only mixed or guardedly positive in their conclusions regarding pay-for-performance plans.”

In effect, we are charging ahead full-bore in adopting these payment systems without knowing if they will really work. I suppose that any system is better than what we have now, which is essentially pay-for-quantity, giving financial incentives to utilize more medical care.

But without definitive data, pay-for-performance proponents may be setting themselves up for disappointment once the effects of this type of reimbursement system are analyzed.

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