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January 01, 2011


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Hope Hetico RN MHA

On Pay-for-Performance Initiatives

The concept of pay-for-performance (P4P) is an unproven trend, according to the Congressional Research Service, an arm of the Library of Congress. Initial studies suggested that pay-for-performance programs might change performance on quality measures that are used for the basis of bonus payments. Claims that P4P programs are cost saving in the long run are largely speculative, however, since determining whether a certain healthcare practice produces good results usually requires controlled studies rarely possible for a social policy.

A recent study published in the New England Journal of Medicine found that P4P accelerated quality improvements for some conditions in the short term. However, once targets were met, the rate of quality improvement slowed, and the quality of care actually declined for other conditions which were not incentivized. (N Engl J Med. 2009 Jul 23; 361(4):368-78). Research shows there is a fundamental problem with P4P programs: They have had little to no impact on quality.

Moreover, physician pay is contingent on them believing that goals are fair, measures appropriate, performance accurately tallied, and incentives worthwhile.

Dr. David Edward Marcinko


"Real funding for real work is a non-negotiable starting point."

And that's exactly what the PCMH proponents don't realize. Asking family physicians to do more work and take on more administrative chores in the hope that someday, someone will pay you fairly for doing so is just a non-starter!

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