Quote:
Originally Posted by BrendaB_MD
So what do you guys propose? I think it is important to distinguish between the general principle of P4P and the methods by which it is implemented. On a philosophical level:
Should doctors be evaluated?
Should doctors' rewards be linked to their performance?
If so, what methods should be used to evaluate performance (e.g. process based or outcome based)?
How should physicians performance be rewarded? Should it be strictly informational or financial. Should performance metrics be made public?
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should doctors be evaulated?
yes we should and we are. the hospital keeps track of my admissions, re-admissions, infection rate, mortality rate. we have peer review, adverse outcome review, sentinel event review. the state monitors rx writing, the insurance companies monitor the referrals and utilization. we have to be board certified then keep getting re-certified.
i don't know what else you want other than going public with the data which as teratos already pointed out will be a very very very bad idea because non medical people do nolt understand the variables. when, not if, i have a bad outcome and i think i could have done something better it goes to peer review and morbidity and mortality conferrence whose records are sealed..i have no problem standing infront of fellow obs/surgeons and tearing down a case but if a patient hears about the 10 different ways the procedure could have been done differently then it will seem like i was negligent when in fact none including the original one may have had a better outcome.
so we have these per reviews and m&m's to learn from experience and that is what really counts in this..the more i see the more i learn that our medical books barely cover the surface of what we need to do and the system in place now is continuing to evolve. we sit in monthly m&m's and been onvolved in one peer review of a case and going through it is rough but it is amazing to sit in a room of my peers and superiors and be grilled, questioned and get view points on how to handle things this way or that way..basically be in a room with 300plus years of practice experience and while rough it is rewarding to learn from it, and at the end be aqpprocahed and told that something similar happened or hear about some of their bad outcomes and if a public system is implemented all that wealth of experience and candor would likely vanish
are our "rewards" linked to performance?
they already are, if you have hmo contracts and follow formulary, if your referral rate is low or at least within nomrla range of your peers in your area then you get quarterly bonuses.