The latest buzz phrase seems to be "Pay for Performance" (PFP). Articles that discuss the topic often are ambiguous about what PFP means. How will performance be measured? That's the rub. Typically, studies which purport to measure "quality" measure the degree to which certain guidelines are adhered to, wherein quality equals conformance, begging the question are the guidelines even valid. "Performance" will, likely , in part, be "measured" in the same way.
Dr. Charles Francis, president of American College of Physicians, recently participated in a Pro & Con section in Internal Medicine News. The question was " would pay for performance result in better care" He was Pro. He implies that the market is demanding PFP to ensure high quality performance. The third payers are demanding it. How many patients have you heard express the idea that they are very interested in physicians being payed in part by their "quality" of care"? Patients are interested in the physician taking care of the problem at hand. Does anyone deny that the insurance companies, and Medicare are primarily interested in cutting costs? Follow the money. Don't judge a plan or activity by its purported mission, but ask what incentives and restraints does that entity operate under. The incentive of third party payers is to decrease costs.
Dr. Francis's opponent in this quasi-debate was Bruce Vladeck, former administrator of the Health Care Financing Administration. Mr. Vladeck , a non-physician,and he had the most cogent insight expressed by either participant. He said in part about physicians "To change behavior through relatively modest economic incentives is much less powerful than targeting the activities that make professions feel good about themselves-where their identity is closely tied"
While Mr. Vladeck does not explain how to do this, at least he realizes what , I think, most doctors are really about, our identity is tied strongly to doing a good job for our patients.
Unfortunately, to my ears, Dr. Francis's comments sounded like what an administrator of a insurance plan would say ( "...fragmented care,....helping to raise the bar on quality.. foster continuous quality improvement..to meet or exceed evidence based standards." The ACP seems to be the "Newest best friend" of managed care and the powers that be that hold the medical purse strings.