Tag: "pay for performance"

Pay for Performance

Directives to trim waiting lists using pay-for-performance targets have created a host of unintended consequences for the British National Health Service (NHS).          

Targets create incentives to manipulate patient records and official statistics, corrupting data used to measure system performance. Spot checks of NHS hospitals show that they extensively manipulated the data that were supposed to be used to compile waiting lists. Techniques included deliberately booking operations on days patients were known to be on vacation (thus creating an excuse to suspend them from waiting lists in their absence [link], excluding patients from lists if they had waited "too long" and arbitrarily reclassifying patients so that they were shifted to lists that were not monitored [link].

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Dec 15, 2008 | 5 comments | by

Hits & Misses – 2008/11/25

Pay for Performance Doesn't Work – Again. "Of the six measures initially rewarded by [P4P], only cervical cancer screening showed consistently positive returns."  [link] Hat tip to Jason Shafrin.

Mad DoctorsDoctor Angst. Nearly half of primary care does plan to cut their patient load or quit medicine entirely. About 60% would not recommend medicine as a career. [link] 

Free Diagnosis Online. We tried it, and it's actually pretty good. [link]

$1,000 Deductible. That's the new median for individuals in employer plans, according to a Mercer report [gated, but with summary].

Health Insurers: Force People to Buy Our Product and We'll Take Everybody. Lenin was wrong. The capitalists aren't going to sell the hangman's noose to their enemies; they're going to give it away. [link]

Nov 25, 2008 | 3 comments | by

Hits & Misses – 2008/09/11

  • Bankruptcy Update. Remember the claim that 50% of all bankruptcies are caused by medical debt? Turns out it’s only 5%. [link]
  • Pay-for-Performance is Unsafe. P4P tends to encourage cookbook medicine and that can be hazardous to your Amishhealth, says one cardiologist. [link]
  • Good News and Bad News on the Fat Gene. The bad news: 30% of all Americans of European descent have it. The good news: A study of the Amish shows that a few barn raisings and other rigors of rural life are enough to overcome genetic destiny. [link]
  • Wal-Mart Makes Us Thin! Expansion of their outlets is associated with less obesity, and the “effects appear strongest for women, minorities, urban residents and the poor.” See study here. Hat tip to Tyler Cowen at his blog.
Sep 11, 2008 | 2 comments | by

Policies that Fail

This is David Henderson, reviewing David Dranove's book Code Red in Regulation.

On Certificate of Need Laws:

Illinois hospitals today are located where Illinoisians lived in the 1950s, and the hospitals that received Hill Burton licenses (at that time) dictate which of today's growing suburbs get to have local hospital services.

On Pay for Performance:

P4P is not payment for outcomes.  Rather, it is almost entirely about paying doctors and hospitals for following various processes, in the hope that those processes will lead to better outcomes.  Dranove also points out some unintended consequences of P4P.  In England, he notes, doctors are rewarded for scheduling appointments on short notice. The unintended but entirely predictable response is that some doctors "refuse to schedule appointments more than two or three days in advance.

On P4P Over the Top:

After Britain's Labour government decreed that hospitals must treat patients within four hours of their entering the building, hospitals started…having patients wait in ambulances outside the hospital so that they would not violate the four-hour rule.

Code Red

Sep 05, 2008 | 2 comments | by

Pay for Performance (P4P): It Doesn’t Work

In a study (unfortunately gated) published in the July/August issue of Health Affairs, Steven Pearson of Massachusetts General Hospital and coauthors evaluate the impact on quality of all P4P programs introduced into physician group contracts during 2001-2003 by the five major commercial health plans operating in Massachusetts.  Overall, P4P contracts were not associated with greater improvement in quality compared to a rising secular trend.

Sep 03, 2008 | 4 comments | by
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