Can We Pay for Value, Not Quantity?
Paying physicians:
By 20
17, physicians will be rewarded or penalized on the basis of the relative calculated value of the care they provide to Medicare beneficiaries.
But is this a good idea?
…[T]he practical reality is that the Centers for Medicare and Medicaid Services (CMS), despite heroic efforts, cannot accurately measure any physician’s overall value, now or in the foreseeable future. Instead of helping to establish a central role for performance measurement in holding providers more accountable for the care they provide and in informing quality- and safety-improvement projects, this policy overreach could undermine the quest for higher-value health care.
What’s happening now?
CMS has based the value modifier on the Physician Quality Reporting System (PQRS)… It now consists of more than 200 measures, mostly of recommended clinical processes, prevention, and care coordination…[yet] less than 30% of eligible professionals actually report their data to CMS.
What do doctors really think?
The meager rate of physician participation in the PQRS also suggests that something is fundamentally wrong — physicians simply do not respect the measures, and for good reason. PQRS measures reflect a vanishingly small part of professional activities in most clinical specialties. A handful of such measures can provide a highly misleading snapshot of any physician’s quality. Research shows that performance on specific aspects of care does not predict performance on other components of care. Primary care physicians manage 400 different conditions in a year, and 70 conditions account for 80% of their patient load. Yet a primary care physician currently reports on as few as three PQRS measures.
Source: Berensen and Kaye in the NEJM. See Linda Gorman’s prophetic post here.
Classic case of overreach. Federal monitors can never replicate basic market incentives.
Completely. We’re just displacing costs.
Yet they continue to try
And fail
so much of what is weighted just does not reflect truly patient care. doctors perform tasks based on discretion for a reason; they don’t perform certain tasks on a case-by-case basis for that same reason.
If only the Fed knew that
Now what’s being treated are statistics, not patients.
Much like any other service we get and pay for, the consumer(patient) should be the best judge of value for the interaction with the physician, not a third party, and certainly not the Government.
Less is more. Just saying.
But actually, a lot of studies suggest that the US over consumes healthcare. 50% of all prescriptions are unnecessary by physicians’ own words.
More results from the perverse incentives at play.
^^^ No better example than Medicare.
I kind of think of all the cases when patients will pressure doctors to prescribe a certain medication even when they really don’t need it (just look at viral vs. bacterial redeyes).
Our country advertises medication very heavily though. It makes people think they need something because they self-diagnose.