Monday, May 24, 2010

P4P(Pay for performance) harmful effects may impact surgeons as well-I am shocked,shocked

This paper (see here) regarding P4P and its impact on surgery or the lack of it for the obese patient has received at least two appropriate commentaries in the medical blog world. DrRick (see here) and Robert Centor (see here)have highlighted the article pointing out yet another example of the unintended consequences of P4P.

The main point is that if surgeons or the institutions in which they practice are penalized for certain surgical complications or length of stay in the hospitals it is likely that when possible surgeons just might tend to avoid elective surgery in patients who are in a group likely to have a higher than average complications rate.Such a group is the obese.

Goodhart's Law which indicates that when a measure become a target it looses the characteristics that made it a valid measure is a valuable insight capable of explaining a lot of behavior. One of my favorite examples is the ill fated " four hour pneumonia rule.See here and here. Teaching to the test and treating the chart are phenomena in same general category.These things are so common and predictable that maybe we should not call the consequences unintentional. The planners ( at least some of them ) must have it figured out by now but just do not care.

Physicians have been criticizing the P4P nonsense for years now but the caravan moves on.Here are some comments I made in 2008 with reference to an excellent essay on the subject by the prolific Dr. Roy Poses.

4 comments:

Michael Kirsch, M.D. said...

Pay-for-Performance fails miserable in its missin to measure and encourage medical quality. You cannot measure medical quality numerically. What really counts in medicine, cannot be counted. So, instead, we will be measuring what can be counted falsely claiming that these data are surrogates for medical quality. It will be a huge hassle for physicians and will lead to gaming of the system. Who wins here? www.MDWhistleblower.blogspot.com

james gaulte said...

Who wins? Not the patients and not the physicians.I guess the winners are the nominal payers who limit payments under the bogus quality banner.

Doug Perednia, MD said...

Actually, there is a very clear and profound winner in the P4P environment - the administrators and bureaucrats who produce and administer these programs. Every one of these programs consumes valuable healthcare dollars and creates jobs. Creating the program. Drafting information about the program. Disseminating information about the program. Collecting data. Transmitting data. Tabulating data.
Reporting on data. Doing interviews about the results. Unfortunately not one single American is treated or made better by the process, but there is definitely a clear "winner". Lots of losers, too - namely everyone else.

Michael Kirsch, M.D. said...

We abandoned a 'quality' initiative in our office, because the hassle, time and expense wasn't worth the pocket change we were promised, and never received. See http://bit.ly/3hPKay