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Pay for performance (P4P)--How's my driving? – Observations from a Patient

Posted Dec 23 2008 2:38pm

I just wanted to take this post and republish here as the writer was kind enough to reference one of my posts from a coupe months back.  The one message I see here is that event patients are beginning to wonder about pay for performance as well.  Nice write up and opinion.  BD 

The first time I heard about P4P, I thought what a great old idea!  Didn't they call it "piecework" back in the day?  Why shouldn't I be paid more if I could churn out 60 widgets in an hour compared to the guy next to me making only 43?  Well for one, maybe his widgets were better than mine.  Maybe I was working with inferior widget parts.  Maybe someone on the widget part line slowed him down.  There may be reasons why we are no longer paid by the "piece." 

Surely churning out patients was not what health insurance companies had in mind, so P4P must be tied to patient outcomes or satisfaction or some other measure that the physician is performing at his best.  So what's the fuss?  As a patient, I certainly would like to know that my physician is a top performer.  Why wouldn't they want data about their patient outcomes and satisfaction collected, analyzed and shared with insurance companies and patients?  Maybe their patients are sicker, poorer, and unable to afford to comply or follow up.  Maybe they have no control over the interactions between staff and patients. Maybe they are powerless to fix system problems within a hospital. There may be reasons why physicians are leery of embracing P4P sponsored by insurance companies.  

Today, buried in an otherwise engaging post on The Medical Quack, I found a reference to a kind of P4P that could affect me more directly in the not so distant future. On it's face,like piecework and physician P4P it seems like a great idea. I drive carefully and I pay less money for car insurance. I have a spotless driving record--no accidents or tickets (except the parking tickets my sons get when they borrow my car).  I should be paying less for car insurance. It seems Progressive Insurance has a device that tracks your driving habits, coupled with a program called My Rate promising lower rates. You can even log on to the website and track your projected renewal rate based on your driving. What if my rates go up? What if I can't get insurance anywhere?  Maybe the device was faulty. Maybe I lent my car to my son (the one who gets the parking tickets).  Maybe I was driving erratically while dodging the other nuts on the road. Maybe there are reasons to suspect the motives of insurance companies.

I'm not sure money is the best motive for improving your widget making, driving, or patient care. I'm pretty sure insurance companies and other third parties that stand to gain while we lose are NOT the best choice to drive improvement.

Resilient Ambassadors of Change: Pay for performance (P4P)--How's my driving?

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