I welcome attacks on the dangerous and muddled headed concept and practice of P4P. There is so much wrong with it that I hardly know where to begin. A good place to begin is this most recent entry by Dr.Roy Poses of Health Care Renewal. He summarizes most of the problems with pay for performance in this posting. To his excellent essay I would only add never forget Goodhart's Rule, which tell us that once a measurement becomes a target or a goal it is no longer a valid measure or more accurately phrased
Once a measure is made a target for the purpose of conducting policy, it will loose the information content that would qualify it to play such a role.
Dr. Robert Centor in his blog sends us to an extremely well written article in JAMA. You need a subscription but he gives us at least a hint of the flavor of that satire here.Ridicule sometimes is a sharper sword than thoughtful critiques.
I am afraid that in spite of biting satire and the elucidation of valid arguments against P4P, too many of our fellow physicians continue to collaborate with this travesty that can only serve to further accelerate the downward spiral to the ethics and pride of the medical profession.
Critics of the gate-keeper version of managed care were often told that the train had already left the station and now critics of P4P are being told that as well. The gate-keeper train ultimately derailed and I believe docs should let the P4P express train leave without them being aboard.