Pay For Performance Is Not All That It Has Cracked Up to Be-Time to Rethink As Money Is Not Creating Better Health Outcomes
Posted Jan 26 2011 5:54pm
The study has shown that financial incentives did not improve the quality of care and clinical outcomes for patients with hypertension in primary care in the UK according to the study. I always wondered about P4P in healthcare anyway as I spent over 20 years in outside sales, now there’s the area where it does work and where it belongs. Sales and money go together and the same philosophy doesn’t fit all areas of healthcare.
I think this goes back to show that the real key here is education with patients and MDs playing their role to add to what the patient finds through their own education efforts too. Somebody better tell United Healthcare about this study as they want everybody on P4P, even oncologists and have a program for pharmacists at Walgreens to earn money, but perhaps with the pharmacists though this is entering more into the “sales” model instead of healthcare with this incentive?
Actually when it comes to pay for performance for Oncology, I think that’s a difficult program to create a model for, much less put in place as it has some real potential ethics conflicts and would create some not so nice unintended consequences.
The ultimate solution is to get the price of drugs and other services down to where the monkey can be taken off the doctor’s back, and of course this could not be done entirely, but there sure could be a lot more efforts in attacking the high costs via this methodology versus dumping more business intelligence software on their backs to fit into their already busy schedule of taking care of patients, The doctors are there to take care of us so if they had drugs and tools that were priced better, their job would be easier and we could potentially see some better outcomes with this model.
Heart attacks, renal failure, heart failure or mortality in both patients who had started treatment before 2001 and patients whose treatment had started close to the implementation of P4P had about the same numbers so certainly P4P has a good motivation voice, but when you look at what is actually achieved and the additional stress it creates too, well back to better priced drugs and services along with education as being the solutions no matter how many algorithms you run. BD
"Governments and private insurers throughout the world are likely wasting many billions on policies that assume that all you have to do is pay doctors to improve quality of medical care," says senior author Stephen Soumerai, professor in the Department of Population Medicine at Harvard Medical School and Harvard Pilgrim Health Care Institute. "Based on our study of almost 500,000 patients over seven years, that assumption is questionable at best."
"Policymakers sometimes legislate large and expensive policies based on their beliefs without the requisite hard evidence," says Soumerai. "Policy makers in the U.S. and in Canada who are attempting to enact such programs need to think hard about other more effective approaches."