I don't think the proposals for caps apply to individual doctors but are applied at an aggregate level (e.g. hospital). On the other hand, there are lots of other systems that are being put in place for pay for performance. These tend to reward doctors for practicing evidence-based medicine and using resources wisely. While the current systems are not perfect, I think they will get better over time. I don't think these are a bad thing. As Wennberg's research shows, there is huge variation in practice. Thus, a large percentage of doctors follow suboptimal practice. For example, in the book, Epidemic of Care, the authors (former CEO of an HMO) found that only 50% of doctors in their care network managed diabetes appropriately. Similar results have been found for management of patients with heart conditions (e.g. prescribing beta blockers). As the saying goes, "What gets measured gets managed, what get's rewarded gets done". Thus, measurements and rewards will provide the incentives to improve performance.
Most of the doctor incentive systems are process based vs. outcome based. Thus, doctors are rewarded for following evidence-based guidelines but not for turfing sick patients.
I think one can argue about the methods used to measure and reward performance; however, I think the overall strategy makes sense. Why should medicine be any different from anything else in this regard?
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Originally Posted by AUCMD2006
why do we continue to punich doctors over and over and over and over again? if we want to do pay for performance then apply it broadly! can we have CEOs that run companies to the ground work on P4P? maybe instead of the 100million golden parachute they can have their pay deducted when the factory workers don't show up to work, or drink do drugs while working thereby reducing the productivity
how about lawyers go on P4P? we will have lawyers reduce thier fees when their clients don't take thier advice and drink and drive getting another DUI.
when i keep hearing about all the crap thery want is to lead and be role models for i just think back to the movie "old school" when frank the tank "leads" the streak but nobody follows...physicians are the frank the tanks of the world because we all think we should lead and be professional models while the rest of the professions just laugh all the way to the bank
i am spending my time filling my head with knowledge, working 70-90hrs a week so that i can practice medicine...by practicing medicine i am putting out a product (medical advice) why should i be paid less for it?
and you think this P4P is so great? i will bet my left epidymidis that this will backfire so quick you will wonder what the hell happened..i'll spell it out for you: P4P basically pays more for good results, good results come from practicing evidence based medicine but mostly good results come from healthy compliant patients....the only thing that P4P is going to accomplish is that more and more docs are going to tailor their practices to have good numbers by only keeping healthy compliant patients..the gomers and gomeres will be turfed to your local ER where an already crumbling infrastructire will be further strained taking care of the wake left over from your wonderful P4P system.
is it coming yes but many docs are not taking it and are already starting to refuse insurance. so the US does not need socialized medicine to have 6 month waiting times we just need to further burocratize and penalize doctors to the point where it will no longer be worth it to work
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