Friday, March 19, 2010
Does Pay for Performance Improve Health Care Quality?
This post by Evan Falchuk, JD, appeared at Better Health.
The Jobbing Doctor, a primary care doctor in the U.K., writes about the British version of what Americans call "Pay for Performance," or "P4P."
He says something I've said many times before (like here, here and here), which is this: Incentives fail because they try to treat medicine as an assembly line process when it's not.
But what's most interesting about his post is that it could have been written by a doctor from anyplace on the planet Earth.
The Jobbing Doctor talks about a U.K. program that started in 2004 called the Quality and Outcomes Framework, or "QoF." Now, the American "P4P" is a much more catchy name, so score one for American marketing. But it doesn't matter what you call it, that which we call a rose would, by any other name smell as sweet.
Or, as in this case, as sour.
According to the Jobbing Doctor, QoF has actually increased costs (or at least doctors' income; he says it went up 33%) because the government seemed to have underestimated the extent to which doctors were already delivering high quality primary care. He also notes that because the guidelines are so crude and so focused on certain illnesses, there are incentives to meet targets rather than understanding a patient's medical condition. It's pretty much the opposite of what doctors are taught to do in their training. And his complaints about QoF sound very similar to complaints from doctors in other countries about the impact of such well-meaning efforts by government and private industry.
Which is the larger point.
As Jobbing Doctor put it so eloquently, measures like these distort the practice of medicine and take it away from what is really important:
The other downside is that ideas like the QoF diminish a profession's values and judgments, meaning that high quality care is not driven by an internal motivation for doing a good and valuable job well, rather we have to be driven by targets. Targets are the antithesis of professionalism.
So, yes, the quality of medical care needs to improve. But how you define quality is the first question that must be answered. If I'm sick, I want my doctor motivated and paid to do "a good and valuable job well."
This post originally appeared on Better Health, a network of popular health bloggers brought together by Val Jones, MD. Better Health's mission is to support and promote health care professional bloggers, provide insightful and trustworthy health commentary, and help to inform health policy makers about the provider point of view on health care reform, science, research and patient care.
Labels: health care delivery, health care ratings, pay-for-performance, quality improvement, reimbursement
posted by the Better Health network at
12:06 PM
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QD: News Every Day--Sunday House vote may set up Senate next week
In advance of the anticipated House vote to pass health care reform on Sunday, Democratic legislators are "jittery" about the measure. Republicans are playing that up and pressuring their colleagues across the aisle. President Barack Obama is applying counter-pressure.
It's far from the end-game that it's been called. Once the House votes, the package heads back to the Senate, which will take up the measure in that legislative body's "deliberative" way. Republicans are threatening endless procedural delays; Democrats counter they can address any procedural points.
Labels: health care reform, QD
posted by Ryan DuBosar at
9:40 AM
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Thursday, March 18, 2010
QD: News Every Day--Spend more to save more
Health care reform will cost more than previously predicted, $940 billion, but also trim more from the federal deficit in the long run, $130 billion in the first 10 years and $1.2 trillion in the second 10 years, the Congressional Budget Office is reporting. The release of those figures sets up a 72-hour window for legislators to consider the bill, and vote possibly by Sunday. (Politico, Washington Post)
H1N1 influenza
New cases continue for H1N1 influenza; 2 million illnesses hospitalized 18,000 and killed 310, according to CDC figures for mid-January to mid-February. Apathy is spreading faster than the disease and the flu season can continue until May, so health officials seek novel venues to encourage vaccination. (WebMD, Chicago Tribune)
Labels: H1N1, health care reform, QD
posted by Ryan DuBosar at
10:13 AM
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Wednesday, March 17, 2010
Insurance Companies Should Pay Primary Care Physicians More
This post by Kevin Pho, ACP Member appeared at Better Health.
I've often given doctors too little credit when it comes to business decisions.
But, in an op-ed published at Reuters, physician Ford Vox argues otherwise.
He notes that doctors, indeed, have tremendous business sense: "How can anybody say that doctors don't have business sense, when not only do most American physicians forge their way in small private practices, but new doctors lay their cards on the table every year? The competitiveness of residencies, where doctors train to become a pediatrician or a cardiologist, correlates strongly with the field's earnings potential."
Insurance companies usually intercede when it comes to financial transactions between doctor and patient.
Instead, why not let doctors have more control over health care dollars, instead of wonks and administrators who have little clinical experience?
Health insurers use nearly one-third of premiums before spending on health care delivery. Dr. Ford contends that, "It's time to boost the rank and responsibility of primary care physicians by handing them the source of insurance company power--the money."
Government officials and health insurers pay constant lip service to the importance of primary care. The only way to truly back up their words is to ensure primary care has the adequate financial resources and independence to do its job properly.This post originally appeared on Better Health, a network of popular health bloggers brought together by Val Jones, MD. Better Health's mission is to support and promote health care professional bloggers, provide insightful and trustworthy health commentary, and help to inform health policy makers about the provider point of view on health care reform, science, research and patient care.
Labels: health insurance, reimbursement
posted by the Better Health network at
1:00 PM
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QD: News Every Day--Health care reform amid rising consumer costs
As clashes continue over using a "deemed passed" procedure to avoid a formal vote on health care reform legislation, business groups are pressuring Democrats who are fence-sitting as party leaders shore up support. (New York Times, AP, Wall Street Journal)
Meanwhile, to offset declining Medicare reimbursement, one California cardiology practice instituted annual fees for unreimbursed items such as notification of test results. The practice instituted three tiers of service, ranging from $500 annually for in-office pro-time and warfarin adjustments and pacemaker follow-ups, $1,800 for priority appointments and e-mail communication, to a concierge option for $7,500. Patients who do not choose one of the three tiers will receive medically needed services, but have to schedule an office visit to discuss non-urgent test results, for example. Consumers face these and similar increasing extra health care costs more often. For example, Medicare's prescription doughnut hole affects seniors at a time when prescription prices are outpacing inflation. (Kaiser Health News)
Labels: concierge medicine, health care reform, medicare, QD, reimbursement
posted by Ryan DuBosar at
11:03 AM
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Tuesday, March 16, 2010
QD: News Every Day--When did voting become passe?
A tally shows the House is struggling to muster enough votes to pass health care reform by a simple majority. The president and House leaders are trying to muster enough votes to pass it, but House representatives either oppose it, or are feeling the pressure from all sides and across the country. (CNN, AP, The Hill, Albany Times Union, TheIndyChannel.com)
With the decision being so polarizing, House leadership is looking to relieve the pressure. Votes? Who needs votes? Representatives don't even need to vote on legislation any more to pass it. (Washington Post)
Labels: health care reform, QD
posted by Ryan DuBosar at
11:28 AM
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Monday, March 15, 2010
QD: News Every Day--Health reform vote by the weekend
A vote on health care reform could come this weekend, with the House members considering whether to pass the Senate's version and then a bill of budget changes. House members are leery of the upper chamber's following through. The Majority Whip is trying to ensure there will be enough votes for passage. Abortion, immigration and costs remain key sticking points. Both sides are applying pressure to those on the fence, and Republicans are trying to make sure Democrats pay a price for victory. (Wall Street Journal, Washington Post, Fox News, Los Angeles Times)
The impact from this weekend's vote will play out over the next decade. Primary care doctors will see a 10% payment boost from Medicare for their office, nursing home and other outpatient visits. Medicare also plans to pilot accountable care organizations that reward primary care doctors for managing multiple chronic illnesses. Doctors and hospitals would band together for payments, similar to a "Mayo Clinic model." (AP) [Editor's note: This post originally stated the legislation applies to rural and inner city physicians. It applies to all physicians for the three conditions stated above.]
Labels: health care reform, medicare, QD, reimbursement, rural medicine
posted by Ryan DuBosar at
10:05 AM
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ACP Internist hosted Grand Rounds on June 16, wrapping up the best of the medical blogosphere. Click here for the complete wrap-up.
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Previous Posts
- Does Pay for Performance Improve Health Care Quali...
- QD: News Every Day--Sunday House vote may set up S...
- QD: News Every Day--Spend more to save more
- Insurance Companies Should Pay Primary Care Physic...
- QD: News Every Day--Health care reform amid rising...
- QD: News Every Day--When did voting become passe?
- QD: News Every Day--Health reform vote by the week...
- Medical News of the Obvious
- QD: News Every Day--Considering health care reform...
- QD: News Every Day--Federal action leads to states...
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