Pay for Performance, a wolf in sheep clothing!
Doctors and institutions that provide better care should earn more money is an idea that may appear good in theory and testing but may not be so sound in wide scale practice. The idea will be good only if its implementation is within narrow perimeters. Wide scale implementation covering complex patient health conditions can only lead to a downgrading of available services and a worsening of access for the poor and those with pre-existing conditions. According to congressional testimony given by Meredith Rosenthal, a professor of health economics and policy at the Harvard School of Public Health, there are currently over one hundred pay-for-performance efforts. Most programs use simple measures of performance: Providers are financially rewarded for achieving goals in, say, childhood immunization rates, the percent of patients receiving aspirin after undergoing coronary bypass surgery, or the length of time required to administer antibiotics to hospitalized pneumonia patients. This may seem like a good thing but as Wes Champion, vice president of Capgemini Health's business strategy and transformation practice said "Quality has crossed over into the CFO's office." The question arises of who is the arbitrator of the quality of care for a particular patient, the doctor and patient or the payer? If programs don't measure what matters, they could actually squeeze out other safety practices, said Richard Ward, CEO of Reward Health Sciences, a consultancy specializing in IT and care management. Ward said he's seen health care providers abandon more worthwhile goals to boost rates of less important services: "The more you standardize, the more people will pursue superficial means [to hit measurement targets]." Worse, as providers feel the pressure to conform to keep their financial bottom line healthy they will likely be pressured to reject patients who are less healthy or less likely to comply with doctors' orders; generally the poor, those with pre-existing conditions and those with mental health issues. Pay for performance will become a negative factor for those it is suppose to help and will continue to worsen patient access to affordable healthcare. The premise of pay for performance is to reward providers who follow good medical practices. Good medical practice is the responsibility of state medical boards, physician and nursing associations, and even health programs of state legislators. It is the responsibility of CFOs to maximize profit. Pay for performance is a theory with good results for limited implementation but wide spread implementation is accepting in to the fold a sheep with big teeth! About the author: Michael Milne is the CEO of Scriptnetics, Inc, the developer of Medscribbler, the first handwriting embedded EMR for the Tablet PC. Visit Medscribbler.com for more information on a handwriting enabled EMR. Do you like this article? Click here to read more!
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