Wednesday, January 30, 2013

Carrots for Doctors

With its ambitious proposal to pay doctors in public hospitals based on the quality of their work — not the number of tests they order, pills they prescribe or procedures they perform — New York City has hopped aboard the biggest bandwagon in health care. Pay for performance, or P4P in the jargon, is embraced by right and left. Pay for performance, or P4P in the jargon, is embraced by right and left. It has long been the favorite egghead prescription for our absurdly overpriced, underperforming health care system. The logic seems unassailable: Reward quality, and you will get quality. Stop rewarding waste, and you will get less waste. QED! P4P!

If only it worked...

Critics, who have evidence from a host of pilot programs, say that the bonuses are typically too small to change behavior; New York’s would be a maximum of 2.5 percent of a doctor’s salary, and most P4P programs pay less than that. Often the performance indicators measure things that are not within the doctor’s control. more

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