Surprise: P4P Doesn’t Work for Nursing Home Care
Quality improvement under P4P was inconsistent. While three clinical quality measures (the percent of residents being physically restrained, in moderate to severe pain, and developed pressure sores) improved with the implementation of P4P in states with P4P compared with states without P4P, other targeted quality measures either did not change or worsened. Of the two structural measures of quality that were tied to payment (total number of deficiencies and nurse staffing) deficiency rates worsened slightly under P4P while staffing levels did not change.
No surprise here.
Just about the only P4P initiative that works in nursing homes is for the family paying the bills to complain to the nursing home administrator and threatens to take grandma out unless care improves. Of course, this only works if the family is paying cash; if grandma is covered by Medicaid the nursing home staff will probably collect grandma in a wheel chair and wish the family farewell and God’s Speed!
I agree with Studebaker. Those bureaucratic surcharges will kill you.
Remind me to never get old.
If it doesn’t work, it shouldn’t be implemented..
I’m not quite sold on the idea of P4P. This approach basically assumes that whether a patient’s health improves or worsens, it’s completely in their physician’s hands. This is not totally true. Granted, the physician plays a major role in treating the patient’s condition and advising them on how to properly continue caring for themselves. However, it’s is totally up to the patients whether they follow through with it or not.
One thing that concerns me about this pay-for-performance strategy is that, since doctors get paid more for those patients who tend to do well, then they will be tempted to choose help them over the ones that needs more help. If this is the case, then who will care for those patients who struggle a little more with staying healthy?
It doesn’t work for nursing home care, and it probably doesn’t work anywhere else either.
Ultimately, P4P makes physicians fully responsible for the outcome on their patient’s health. The truth is that patients spend most of their time outside of their doctor’s office, which means physicians can’t monitor every decision they make regarding their health. Patients usually forget to take their medications at certain times, or forget to get their refills and/or don’t exercise…all these factors play an important role on whether they will stay healthy or not…and needless to say, it’s not up to the physician that’s treating them. The way I see it, this is a two-way street. The physicians do their part by determining what’s wrong with the patient and tell them what needs to be done, and patients do their best to follow instructions. How is quality of care supposed to be improved if the two parties don’t work together?
I agree with Prince, I don’t every want to get old and stuck at an old home, waiting for death to come.
Kumar, aging is a part of life. The only way to deal with it is by improving our health care system!