Carrot on a stick.

BaitAre you chasing the carrot? Have you gotten a nibble yet? Pay for performance continues to grow as a policy, with little evidence supporting that it works. Many of my colleagues feel frustrated over the current methodology of pay for performance (P4P) programs. Each insurance company seems to have its own P4P program. Difficulty incorporating EHR systems into compliant reports causes time consuming hand written or hand entered report generation and increased expense for added ancillary staff. Add to this that the rules change frequently and the carrot never gets any closer is leading me to wonder if it is worth the effort.
There have also been several studies that I have read over the past several weeks that show that it is becoming common practice for some physicians to discharge patients from their practice for noncompliance in receiving recommended cancer screening tests or if they have complex medical conditions that make it difficult to get their vital signs or labs to meet guidelines (so called gaming the system). With more than 30 million more Americans expected to have health insurance in the future, how much more gaming of the system will occur. Is this good for patient care?
If after several attempts at compliance with preventive services fail, I grovel, letting my patients know that my reimbursement from their insurance is adversely effected. In effect, if they are not going to do it for themselves or their families, would they do it for me? I have not studied the response to this or how often I have done this but anecdotally it works. This is certainly a shift in my norm of practicing preventive care for the past 20 plus years.
One quality factor that is especially low in some primary care offices is the child and adolescent annual physicals. Some practices now offer incentives this group of patients. “Get your physical and have a chance to win a gift card for downloading music to your MP3 player.” Now were dangling a carrot in front of our patients so we can get a bigger carrot.
It is also apparent that primary care providers are affected much more by P4P programs then other specialties. When our office provides primary care services to a diabetic patient who follows with endocrinology there is no way to remove them from the panel that we are responsible for. If their hemoglobin A1C is not to goal, our fault. If they see a cardiologist who feels that a BP of 140/90 is ok for a diabetic and stops there medicine, our fault. If their cardiologist or endocrinologist is happy with an LDL of 150 and decreases their statin, our fault. So how long will we chase the carrot.

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