A Devastating Review of Pay-for-Performance

Based on numerous studies reviewed here, pay for performance and public reporting benefit third parties but put patients at risk. Compliance with “best practice” standards does not improve patient outcomes. Adverse effects include physician avoidance of high-risk patients and system gaming by physicians and hospitals. These effects have a disproportionate effect on patients in minority and lower socioeconomic groups. Administrative and claims source data used in such programs are often inaccurate and invalid. Risk-adjustment methods are not adequate to fully account for the complex features of the highly variable patient population in the United States…

While the AMA has promulgated stringent Principles and Guidelines on PFP, these are often forgotten or blatantly ignored as third-party payers (employers, health insurers, and government regulators) feel increasing pressure to do whatever they can to control their escalating costs.

Full report by David McKalip in the Journal of American Physicians and Surgeons.

Comments (6)

Trackback URL | Comments RSS Feed

  1. Brian Williams. says:

    I’m not an economist, but isn’t profit motive the best “pay-for-performance” method that exists in a free market?

  2. Devon Herrick says:

    The problem with pay-for-performance is that many performance indicators are not good proxies for the performance payers are trying to measure. In many instances, it is theoretically possible for providers to improve their standing on performance indicators without actually improving the quality of care delivered.

  3. Tom H. says:

    This is a very good review. If the conlusion had been that P4P works, it probably would have been covered everywhere.

    Needs to get a lot more attention.

  4. Joe S. says:

    Didn’t the CBO come to the same conclusion as Dr. McKlip?

  5. Ken says:

    This is a very good article. Every member of Congress should read it.

  6. Cicak says:

    I’m not super familiar with that area , but it looks to me like the cleosst location listed on the chart is Farmington, with a date of May 1. If you tend to have similar weather to Farmington, I would use that date. You’re right on the edge of the two groups. If it is a mild winter/spring and you are excited, I would follow the yellow schedule. If it is a cold winter-spring and you are more relaxed, I would use the green schedule.